# THE AUSTIN DIAGNOSTIC CLINIC, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1932186640
- **Authorized official:** JOHN REBOK (VICE PRESIDENT)
- **Authorized official phone:** (615) 372-5004

## Contact information

- **Practice address:** 12221 N. MO PAC EXPY, DEPT OF ENDOCRINOLOGY, AUSTIN, TX 78758
- **Practice address phone:** (512) 901-4005
- **Practice address fax:** (512) 901-3905
- **Mailing address:** 2000 HEALTH PARK DR DEPT OF, BRENTWOOD, TN 37027-4525
- **Mailing address phone:** (615) 372-5004
- **Mailing address fax:** (866) 831-4898

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207RE0101X | Endocrinology, Diabetes & Metabolism Physician | — | — | Yes |
| 363L00000X | Nurse Practitioner | — | — | — |

## Other

- **Enumeration date:** 12/23/2005
- **Last updated:** 06/25/2018

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 140347921 | — | TX |