Basic Information
| Provider Information | |||||||||
| NPI: | 1811922461 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HOSPITAL INTERNISTS OF AUSTIN, P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7000 N. MOPAC | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124820045 | ||||||||
| FaxNumber: | 5124769892 | ||||||||
| Practice Location | |||||||||
| Address1: | 7000 N. MOPAC | ||||||||
| Address2: | SUITE 420 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78731 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124820045 | ||||||||
| FaxNumber: | 5124769892 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 03/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | MUTO | ||||||||
| AuthorizedOfficialFirstName: | ALYSA | ||||||||
| AuthorizedOfficialMiddleName: | D. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 5124820045 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Specialist |
ID Information
| ID | Type | State | Issuer | Description | 0798795-02 | 05 | TX | MEDICAID |