Provider Demographics
NPI:1508080516
Name:AUSTIN CHILDREN'S CLINIC, PA
Entity Type:Organization
Organization Name:AUSTIN CHILDREN'S CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:PAULINE
Authorized Official - Last Name:MYERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-338-5130
Mailing Address - Street 1:11673 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-3933
Mailing Address - Country:US
Mailing Address - Phone:512-338-5130
Mailing Address - Fax:512-338-5112
Practice Address - Street 1:11673 JOLLYVILLE RD
Practice Address - Street 2:SUITE 104
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-3933
Practice Address - Country:US
Practice Address - Phone:512-338-5130
Practice Address - Fax:512-338-5112
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent MedicineGroup - Single Specialty