Provider Demographics
NPI:1437493244
Name:INSTITUTE OF RECONSTRUCTIVE PLASTIC SURGERY OF CENTRAL TEXAS
Entity Type:Organization
Organization Name:INSTITUTE OF RECONSTRUCTIVE PLASTIC SURGERY OF CENTRAL TEXAS
Other - Org Name:SETON INSTITUTE OF RECONSTRUCTIVE PLASTIC SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SR DEPT ASSISTANT
Authorized Official - Prefix:MS
Authorized Official - First Name:JAMINE
Authorized Official - Middle Name:ROSE
Authorized Official - Last Name:PADILLA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-324-8320
Mailing Address - Street 1:1400 N IH 35
Mailing Address - Street 2:STE 320
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1926
Mailing Address - Country:US
Mailing Address - Phone:512-324-8320
Mailing Address - Fax:512-324-8326
Practice Address - Street 1:301 SETON PKWY
Practice Address - Street 2:STE 402
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78665-8002
Practice Address - Country:US
Practice Address - Phone:512-324-4815
Practice Address - Fax:512-324-4726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-16
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208200000X, 2082S0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Multi-Specialty
No2082S0105XAllopathic & Osteopathic PhysiciansPlastic SurgerySurgery of the HandGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX203606301Medicaid
TX0A3763Medicare PIN