Organization
AUSTIN DERMCARE MSO, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. MARY ANN SIMS (OFFICE MANAGER)
(512) 476-9195
Entity
Organization
Contact information
Practice address
3807 SPICEWOOD SPRINGS RD, STE 200, AUSTIN, TX 78759-8965
(512) 476-9195
(512) 476-2857
Mailing address
3807 SPICEWOOD SPRINGS RD, STE 200, AUSTIN, TX 78759-8965
(512) 476-9195
(512) 476-2857
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0021HW
BCBS GROUP BILLING ID
TX
01
—
CK3641
RR MEDICARE GRP NUMBER
TX
Enumeration date
01/22/2008
Last updated
05/07/2012
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