Provider Demographics
NPI:1780670505
Name:AUSTIN, TRENT R (MD)
Entity Type:Individual
Prefix:DR
First Name:TRENT
Middle Name:R
Last Name:AUSTIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 ALPINE DR
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47006-8477
Mailing Address - Country:US
Mailing Address - Phone:812-932-3224
Mailing Address - Fax:812-932-3229
Practice Address - Street 1:20 ALPINE DR
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:IN
Practice Address - Zip Code:47006-8477
Practice Address - Country:US
Practice Address - Phone:812-932-3224
Practice Address - Fax:812-932-3229
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2015-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01048884A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
743034605OtherTAX ID
IN000000336036OtherANTHEM PIN
IN5467340001OtherDMERC
IN200255570Medicaid
743034605OtherTAX ID
IN217350Medicare PIN
IN217350AMedicare ID - Type UnspecifiedMEDICARE RENDERING
IN200255570Medicaid