Provider Demographics
NPI:1538331756
Name:AUSTIN GYNECOLOGY ASSOCIATES P.A.
Entity Type:Organization
Organization Name:AUSTIN GYNECOLOGY ASSOCIATES P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:KODACK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-478-7295
Mailing Address - Street 1:900 W 38TH ST
Mailing Address - Street 2:SUITE 420
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1127
Mailing Address - Country:US
Mailing Address - Phone:512-478-7295
Mailing Address - Fax:512-478-4366
Practice Address - Street 1:900 W 38TH ST
Practice Address - Street 2:SUITE 420
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1127
Practice Address - Country:US
Practice Address - Phone:512-478-7295
Practice Address - Fax:512-478-4366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-27
Last Update Date:2008-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1023081056OtherNPI
TX1326009671OtherNPI
TX1396706636OtherNPI
TX00MN94Medicare PIN
TX00G91JMedicare PIN