Provider Demographics
NPI:1720398266
Name:AUSTIN SOUTHWEST ORTHOPAEDIC GROUP, P.A.
Entity Type:Organization
Organization Name:AUSTIN SOUTHWEST ORTHOPAEDIC GROUP, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BOARD CHAIRMAN
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ALBRECHT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-451-1969
Mailing Address - Street 1:PO BOX 52194
Mailing Address - Street 2:DEPARTMENT 959
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85072-2194
Mailing Address - Country:US
Mailing Address - Phone:512-451-1969
Mailing Address - Fax:512-458-2327
Practice Address - Street 1:1180 SETON PKWY
Practice Address - Street 2:SUITE 220
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6178
Practice Address - Country:US
Practice Address - Phone:512-451-1969
Practice Address - Fax:512-458-2327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-18
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7496207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2103178-01Medicaid
TX0A4868Medicare PIN