Provider Demographics
NPI:1437514510
Name:AUSTIN PHYSICIAN ALLIANCE GROUP
Entity Type:Organization
Organization Name:AUSTIN PHYSICIAN ALLIANCE GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:
Authorized Official - Last Name:MARROQUIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-763-4690
Mailing Address - Street 1:316 ESCONDIDO DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-5645
Mailing Address - Country:US
Mailing Address - Phone:512-763-4680
Mailing Address - Fax:512-838-6504
Practice Address - Street 1:316 ESCONDIDO DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-5645
Practice Address - Country:US
Practice Address - Phone:512-763-4680
Practice Address - Fax:512-838-6504
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2018-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty
No213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle SurgeryGroup - Single Specialty