Provider Demographics
NPI:1891840575
Name:AUSTIN ENT ASSOCIATES
Entity Type:Organization
Organization Name:AUSTIN ENT ASSOCIATES
Other - Org Name:J.P. BORDELON M.D. & ASSOCIATES
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLIE
Authorized Official - Middle Name:R
Authorized Official - Last Name:KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-458-6391
Mailing Address - Street 1:7200 WYOMING SPRINGS DR STE 1400
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4306
Mailing Address - Country:US
Mailing Address - Phone:512-458-6391
Mailing Address - Fax:512-580-0097
Practice Address - Street 1:7200 WYOMING SPRINGS DR STE 1400
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4306
Practice Address - Country:US
Practice Address - Phone:512-458-6391
Practice Address - Fax:512-580-0097
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-24
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207YX0007XAllopathic & Osteopathic PhysiciansOtolaryngologyPlastic Surgery within the Head & NeckGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00QF41OtherBCBS
TX084513301Medicaid
TX084513301Medicaid