Provider Demographics
NPI:1811208697
Name:AUSTIN MEDICAL GROUP,PLLC
Entity Type:Organization
Organization Name:AUSTIN MEDICAL GROUP,PLLC
Other - Org Name:COPPER RIDGE MEDICAL CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LOVE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-837-6000
Mailing Address - Street 1:7600 HIGHWAY 29 W
Mailing Address - Street 2:SUITE 5
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-6937
Mailing Address - Country:US
Mailing Address - Phone:512-930-0363
Mailing Address - Fax:512-830-0371
Practice Address - Street 1:7600 HIGHWAY 29 W
Practice Address - Street 2:SUITE 5
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-6937
Practice Address - Country:US
Practice Address - Phone:512-930-0363
Practice Address - Fax:512-830-0371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-28
Last Update Date:2010-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF7516207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty