Provider Demographics
NPI:1528227964
Name:AUSTIN PRIMARY CARE LLC
Entity Type:Organization
Organization Name:AUSTIN PRIMARY CARE LLC
Other - Org Name:AUSTIN PRIMARY CARE LLC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:COOK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-745-3151
Mailing Address - Street 1:101 5TH STREET SE
Mailing Address - Street 2:SUITE G
Mailing Address - City:BARBERTON
Mailing Address - State:OH
Mailing Address - Zip Code:44203-4225
Mailing Address - Country:US
Mailing Address - Phone:330-745-3151
Mailing Address - Fax:330-745-9984
Practice Address - Street 1:101 5TH STREET SE
Practice Address - Street 2:SUITE G
Practice Address - City:BARBERTON
Practice Address - State:OH
Practice Address - Zip Code:44203-4225
Practice Address - Country:US
Practice Address - Phone:330-745-3151
Practice Address - Fax:330-745-9984
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-02
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207Q00000X, 225100000X
OH207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
9054194OtherAETNA
OH2841661Medicaid
OH9376671Medicare PIN
9054194OtherAETNA
OHDN7502Medicare UPIN