Provider Demographics
NPI:1669500815
Name:GEORGE M. AUSTIN, M.D. INC.
Entity Type:Organization
Organization Name:GEORGE M. AUSTIN, M.D. INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PATIENT ACCOUNTS
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:DIECKHOFF
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:816-224-8999
Mailing Address - Street 1:206 NW MOCK AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:BLUE SPRINGS
Mailing Address - State:MO
Mailing Address - Zip Code:64014-2507
Mailing Address - Country:US
Mailing Address - Phone:816-224-8999
Mailing Address - Fax:816-224-3121
Practice Address - Street 1:206 NW MOCK AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:BLUE SPRINGS
Practice Address - State:MO
Practice Address - Zip Code:64014-2507
Practice Address - Country:US
Practice Address - Phone:816-224-8999
Practice Address - Fax:816-224-3121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR8754174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO07414054OtherBLUE CROSS BLUE SHIELD
MOC51764Medicare UPIN
MOH823938Medicare ID - Type Unspecified