Provider Demographics
NPI:1710085089
Name:AUSTIN ENDOMETRIOSIS & FEMALE INFERTILITY CENTER PA
Entity Type:Organization
Organization Name:AUSTIN ENDOMETRIOSIS & FEMALE INFERTILITY CENTER PA
Other - Org Name:AUSTIN ENDOMETRIOSIS & FERTILITY CENTER PA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEIKHOSROW
Authorized Official - Middle Name:M
Authorized Official - Last Name:KAVOUSSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-444-1414
Mailing Address - Street 1:4303 JAMES CASEY ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78145-1188
Mailing Address - Country:US
Mailing Address - Phone:512-444-1414
Mailing Address - Fax:512-444-5621
Practice Address - Street 1:4303 JAMES CASEY ST
Practice Address - Street 2:SUITE A
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78145-1188
Practice Address - Country:US
Practice Address - Phone:512-444-1414
Practice Address - Fax:512-444-5621
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2008-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2406207VE0102X, 207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologyGroup - Multi-Specialty
No207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX097750603Medicaid
C17741Medicare UPIN
TX097750603Medicaid