Provider Demographics
NPI:1598173973
Name:FOREST PARK MEDICAL CENTER AT AUSTIN, LLC
Entity Type:Organization
Organization Name:FOREST PARK MEDICAL CENTER AT AUSTIN, LLC
Other - Org Name:FPMC AUSTN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WILTON
Authorized Official - Middle Name:M
Authorized Official - Last Name:BURT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-330-6745
Mailing Address - Street 1:9600 GREAT HILLS TRL
Mailing Address - Street 2:SUITE 150
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-6387
Mailing Address - Country:US
Mailing Address - Phone:512-517-4159
Mailing Address - Fax:
Practice Address - Street 1:1201 W LOUIS HENNA BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-1203
Practice Address - Country:US
Practice Address - Phone:512-517-4159
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-29
Last Update Date:2014-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital