Provider Demographics
NPI:1992210132
Name:FLOSS 5TH AUSTIN PLLC
Entity Type:Organization
Organization Name:FLOSS 5TH AUSTIN PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARANDA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-221-7419
Mailing Address - Street 1:1011 W 5TH ST STE 120
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-5363
Mailing Address - Country:US
Mailing Address - Phone:512-617-0101
Mailing Address - Fax:512-505-8151
Practice Address - Street 1:1011 W 5TH ST STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-5363
Practice Address - Country:US
Practice Address - Phone:512-617-0101
Practice Address - Fax:512-505-8151
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FLOSS 5TH AUSTIN PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-12-11
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental