Provider Demographics
NPI:1922671635
Name:SATELLITE HEALTHCARE OF AUSTIN LLC
Entity Type:Organization
Organization Name:SATELLITE HEALTHCARE OF AUSTIN LLC
Other - Org Name:SATELLITE HEALTHCARE TECH RIDGE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:GENERAL COUNSEL AND SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:PARDO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-213-9398
Mailing Address - Street 1:300 SANTANA ROW STE 300
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-2424
Mailing Address - Country:US
Mailing Address - Phone:669-236-5947
Mailing Address - Fax:650-625-6007
Practice Address - Street 1:1100 CENTER RIDGE DRIVE
Practice Address - Street 2:BUILDING 2 SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-1061
Practice Address - Country:US
Practice Address - Phone:669-236-5947
Practice Address - Fax:650-625-6007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-20
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QE0700XAmbulatory Health Care FacilitiesClinic/CenterEnd-Stage Renal Disease (ESRD) Treatment
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX110641OtherSTATE LICENSE