Provider Demographics
NPI:1922593250
Name:AUSTIN LIFECARE
Entity type:Organization
Organization Name:AUSTIN LIFECARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHURST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-374-0055
Mailing Address - Street 1:1215 W ANDERSON LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78757-1448
Mailing Address - Country:US
Mailing Address - Phone:512-374-0055
Mailing Address - Fax:
Practice Address - Street 1:8401 N IH 35 BLDG 2
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78753-5751
Practice Address - Country:US
Practice Address - Phone:512-374-0055
Practice Address - Fax:512-374-0085
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-28
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0050XAmbulatory Health Care FacilitiesClinic/CenterFamily Planning, Non-SurgicalGroup - Multi-Specialty