Provider Demographics
NPI:1770511164
Name:AUSTIN SKELETAL TRAUMA SPECIALISTS, PA
Entity Type:Organization
Organization Name:AUSTIN SKELETAL TRAUMA SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:DRAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:BORER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-391-1751
Mailing Address - Street 1:1313 RED RIVER
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1900
Mailing Address - Country:US
Mailing Address - Phone:512-391-1751
Mailing Address - Fax:512-391-1906
Practice Address - Street 1:1313 RED RIVER ST
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1943
Practice Address - Country:US
Practice Address - Phone:512-391-1751
Practice Address - Fax:512-391-1906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-28
Last Update Date:2015-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00588UOtherPTAN
TX100781704Medicaid
TX8H3921OtherBLUE CROSS BLUE SHIELD
TX8H3920OtherBLUE CROSS
TX166061501Medicaid
TX8A2610Medicare PIN
TX8H3920OtherBLUE CROSS
TX8H3921OtherBLUE CROSS BLUE SHIELD
TXI10141Medicare UPIN
TX8C0370Medicare PIN