Provider Demographics
NPI:1982804274
Name:AUSTIN INTERNAL MEDICINE CLINIC, PA
Entity Type:Organization
Organization Name:AUSTIN INTERNAL MEDICINE CLINIC, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTENS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-441-8666
Mailing Address - Street 1:1701 W BEN WHITE BLVD
Mailing Address - Street 2:SUITE 140
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7667
Mailing Address - Country:US
Mailing Address - Phone:512-441-8666
Mailing Address - Fax:512-441-8698
Practice Address - Street 1:1701 W BEN WHITE BLVD
Practice Address - Street 2:SUITE 140
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7667
Practice Address - Country:US
Practice Address - Phone:512-441-8666
Practice Address - Fax:512-441-8698
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXE6239207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX90QCOtherBLUE CROSS BLUE SHIELD
TX90QCOtherBLUE CROSS BLUE SHIELD