Provider Demographics
NPI:1205947710
Name:AUSTIN INFECTIOUS DISEASE CONSULTANTS, PA 080191
Entity type:Organization
Organization Name:AUSTIN INFECTIOUS DISEASE CONSULTANTS, PA 080191
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARIANA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARES
Authorized Official - Suffix:
Authorized Official - Credentials:CMM
Authorized Official - Phone:512-593-7902
Mailing Address - Street 1:1301 W 38TH ST
Mailing Address - Street 2:STE 403
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1000
Mailing Address - Country:US
Mailing Address - Phone:512-459-0301
Mailing Address - Fax:512-459-9701
Practice Address - Street 1:1301 W 38TH ST STE 403
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1013
Practice Address - Country:US
Practice Address - Phone:512-459-0301
Practice Address - Fax:512-459-9701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1216884802Medicaid
TX00F59EOtherBCBS
TX00F59EMedicare ID - Type Unspecified