Provider Demographics
NPI:1750393229
Name:THE OBGYN GROUP OF AUSTIN PA
Entity type:Organization
Organization Name:THE OBGYN GROUP OF AUSTIN PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:F
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:512-420-2919
Mailing Address - Street 1:1301 W 38TH ST
Mailing Address - Street 2:#300
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705
Mailing Address - Country:US
Mailing Address - Phone:512-454-5721
Mailing Address - Fax:512-454-2801
Practice Address - Street 1:1301 W 38TH ST
Practice Address - Street 2:#300
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-454-5721
Practice Address - Fax:512-454-2801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-13
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093813601Medicaid
TX093813601Medicaid