Provider Demographics
NPI:1255395810
Name:HURT, JACKNOW, MOORE, CONNOR, WELLS, MICHELS, YURCO, LISTROM & HUANG
Entity type:Organization
Organization Name:HURT, JACKNOW, MOORE, CONNOR, WELLS, MICHELS, YURCO, LISTROM & HUANG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:J
Authorized Official - Last Name:HAAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-579-4000
Mailing Address - Street 1:PO BOX 28770
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755
Mailing Address - Country:US
Mailing Address - Phone:512-579-4000
Mailing Address - Fax:512-439-2814
Practice Address - Street 1:3445 EXECUTIVE CENTER DR
Practice Address - Street 2:STE 250
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731
Practice Address - Country:US
Practice Address - Phone:512-579-4000
Practice Address - Fax:512-439-2814
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HURT, JACKNOW, MOORE, CONNOR, WELLS, MICHELS, YURCO, LISTROM & HUANG
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-12
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207ZP0102X
TX00RM54207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical PathologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX112538701Medicaid
TX00RM54Medicare UPIN