Provider Demographics
NPI:1497798193
Name:AUSTIN NEPHROLOGY ASSOCIATES, PA
Entity Type:Organization
Organization Name:AUSTIN NEPHROLOGY ASSOCIATES, PA
Other - Org Name:CAPITAL NEPHROLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:L
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-382-0037
Mailing Address - Street 1:8140 N MOPAC EXPY
Mailing Address - Street 2:BUILDING II, SUITE 150
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8860
Mailing Address - Country:US
Mailing Address - Phone:512-382-0037
Mailing Address - Fax:512-382-0075
Practice Address - Street 1:3000 NORTH IH 35
Practice Address - Street 2:SUITE 635
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1804
Practice Address - Country:US
Practice Address - Phone:512-320-1500
Practice Address - Fax:512-320-1588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080200102Medicaid
TXTXB138644OtherMEDICARE PIN FOR BASTROP, CALDWELL, HAYS, AND WILLIAMSON COUNTIES
TX080200102Medicaid