Organization
AUSTIN DIAGNOSTIC CLINIC, PA
Active
Other names
Austin Diagnostic Clinic
Organization subpart
No
Provider details
NPI number
Authorized official
ELLEN M ANDREW (CREDENTIALING SPECIALIST)
(512) 901-4937
Entity
Organization
Contact information
Practice address
12221 MOPAC EXPRESSWAY NORTH, DEPT OF IMAGING SERVICES, AUSTIN, TX 78758-2483
(512) 901-8729
(512) 901-8755
Mailing address
12221 MOPAC EXPRESSWAY NORTH, DEPT OF IMAGING SERVICES, AUSTIN, TX 78758-2483
(512) 901-8729
(512) 901-8755
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
—
—
247100000X
Radiologic Technologist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
140347945
—
TX
Enumeration date
02/21/2006
Last updated
11/16/2010
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