Provider Demographics
NPI:1689869463
Name:AUSTIN ASSOCIATION OF OTOLARYNGOLOGISTS
Entity Type:Organization
Organization Name:AUSTIN ASSOCIATION OF OTOLARYNGOLOGISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MELBA
Authorized Official - Middle Name:F
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-328-4999
Mailing Address - Street 1:4407 BEE CAVES RD
Mailing Address - Street 2:1-112
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78746
Mailing Address - Country:US
Mailing Address - Phone:512-328-4999
Mailing Address - Fax:512-328-4979
Practice Address - Street 1:4407 BEE CAVES RD
Practice Address - Street 2:1-112
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746
Practice Address - Country:US
Practice Address - Phone:512-328-4999
Practice Address - Fax:512-328-4979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-13
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH2558174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3277078OtherBLUELINK
3266435OtherDEA# BL
TX3277078OtherBLUELINK