Provider Demographics
NPI:1407805419
Name:AUSTIN NEUROLOGICAL CLINIC
Entity Type:Organization
Organization Name:AUSTIN NEUROLOGICAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-637-5894
Mailing Address - Street 1:711 WEST 38TH STREET
Mailing Address - Street 2:BUILDING F1
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1181
Mailing Address - Country:US
Mailing Address - Phone:512-458-6121
Mailing Address - Fax:512-452-9171
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:BUILDING F 1
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1121
Practice Address - Country:US
Practice Address - Phone:512-458-6121
Practice Address - Fax:512-452-9171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2018-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112537902Medicaid
TX112537902Medicaid