Provider Demographics
NPI:1780009522
Name:FAMILY MEDICINE CENTER OF AUSTIN, P.A.
Entity Type:Organization
Organization Name:FAMILY MEDICINE CENTER OF AUSTIN, P.A.
Other - Org Name:FAMILY MEDICINE AUSTIN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICELA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-433-7695
Mailing Address - Street 1:PO BOX 411779
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64141-1779
Mailing Address - Country:US
Mailing Address - Phone:512-729-5974
Mailing Address - Fax:512-637-4991
Practice Address - Street 1:6633 US 290 FRONTAGE ROAD
Practice Address - Street 2:SUITE 300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78723
Practice Address - Country:US
Practice Address - Phone:512-729-5974
Practice Address - Fax:512-637-4991
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-04
Last Update Date:2022-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty