Provider Demographics
NPI:1518928787
Name:AUSTIN POSITRON EMISSION TOMOGRAPHY
Entity Type:Organization
Organization Name:AUSTIN POSITRON EMISSION TOMOGRAPHY
Other - Org Name:AUSTIN PET & IMAGING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:PETERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-340-0963
Mailing Address - Street 1:11044 RESEARCH BLVD
Mailing Address - Street 2:SUITE D100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-5263
Mailing Address - Country:US
Mailing Address - Phone:512-340-0963
Mailing Address - Fax:
Practice Address - Street 1:11044 RESEARCH BLVD
Practice Address - Street 2:SUITE D100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-5263
Practice Address - Country:US
Practice Address - Phone:512-340-0963
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-29
Last Update Date:2008-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXFTNX10Medicare PIN
TXP00316456Medicare PIN