Provider Demographics
NPI:1770030165
Name:INDEPENDENT AU AGENCY
Entity Type:Organization
Organization Name:INDEPENDENT AU AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING SPECIALIST
Authorized Official - Prefix:MISS
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:KUTAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-727-0099
Mailing Address - Street 1:1212 WEST AVENUE
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78201
Mailing Address - Country:US
Mailing Address - Phone:210-727-0099
Mailing Address - Fax:210-855-7974
Practice Address - Street 1:1212 WEST AVENUE
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78201
Practice Address - Country:US
Practice Address - Phone:210-727-0099
Practice Address - Fax:210-855-7974
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-02
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service