Provider Demographics
NPI:1457549305
Name:AUSTIN SURGEONS PLLC
Entity Type:Organization
Organization Name:AUSTIN SURGEONS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:MELDRUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-371-0957
Mailing Address - Street 1:3901 MEDICAL PKWY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-4027
Mailing Address - Country:US
Mailing Address - Phone:512-467-7151
Mailing Address - Fax:512-467-8809
Practice Address - Street 1:3901 MEDICAL PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-4027
Practice Address - Country:US
Practice Address - Phone:512-467-7151
Practice Address - Fax:512-467-8809
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-04
Last Update Date:2007-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX080596201Medicaid
TX080596201Medicaid