Provider Demographics
NPI:1710301874
Name:FLORA MEDICAL CLINIC-PLLC
Entity Type:Organization
Organization Name:FLORA MEDICAL CLINIC-PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AUDREY
Authorized Official - Middle Name:
Authorized Official - Last Name:GLASER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-476-9934
Mailing Address - Street 1:3921 STECK AVE STE A110
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8647
Mailing Address - Country:US
Mailing Address - Phone:512-476-9934
Mailing Address - Fax:512-476-8404
Practice Address - Street 1:3921 STECK AVE STE A110
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8647
Practice Address - Country:US
Practice Address - Phone:512-476-9934
Practice Address - Fax:512-476-8404
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-10
Last Update Date:2023-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207R00000X
TXL0347261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H24517Medicare UPIN