Provider Demographics
NPI:1518080415
Name:CENTRAL AUSTIN DERMATOLOGY, P.A.
Entity Type:Organization
Organization Name:CENTRAL AUSTIN DERMATOLOGY, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JAY
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:HENDRIX
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-450-1001
Mailing Address - Street 1:720 W 34TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1205
Mailing Address - Country:US
Mailing Address - Phone:512-450-1001
Mailing Address - Fax:512-302-9723
Practice Address - Street 1:720 W 34TH ST
Practice Address - Street 2:SUITE 210
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1205
Practice Address - Country:US
Practice Address - Phone:512-450-1001
Practice Address - Fax:512-302-9723
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-08
Last Update Date:2015-05-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081333901Medicaid