Provider Demographics
NPI:1790127264
Name:SOUTH AUSTIN HEALTHCARE COMPANY
Entity Type:Organization
Organization Name:SOUTH AUSTIN HEALTHCARE COMPANY
Other - Org Name:RITE-AWAY PHARMACY #4
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,MGR,AO
Authorized Official - Prefix:
Authorized Official - First Name:ROHIT
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAUDHARY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-289-5775
Mailing Address - Street 1:2410 E RIVERSIDE DR
Mailing Address - Street 2:D-4
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78741-3083
Mailing Address - Country:US
Mailing Address - Phone:512-827-2250
Mailing Address - Fax:512-582-8519
Practice Address - Street 1:2410 E RIVERSIDE DR STE D4
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78741-3053
Practice Address - Country:US
Practice Address - Phone:512-827-2250
Practice Address - Fax:512-582-8519
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
TX286643336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2141343OtherPK
TX146871/TXMedicaid