Provider Demographics
NPI:1801317904
Name:AUSTIN KIDNEY ASSOCIATES, P. A.
Entity type:Organization
Organization Name:AUSTIN KIDNEY ASSOCIATES, P. A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:DIVYA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIWAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-458-5800
Mailing Address - Street 1:300 E HIGHLAND MALL BLVD STE 1A
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78752-3746
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8620 BURNET RD STE 400
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78757-7034
Practice Address - Country:US
Practice Address - Phone:512-334-1810
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-29
Last Update Date:2018-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical