Organization
AUSTIN REGIONAL CLINIC, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANAS DAGHESTANI MD (CEO)
(512) 419-0707
Entity
Organization
Contact information
Practice address
12779 WEST SH 29, LIBERTY HILL, TX 78642
(512) 778-7003
(512) 406-7317
Mailing address
6210 E US HWY 290, SUITE 240 - CREDENTIALING, AUSTIN, TX 78723-1098
(512) 338-3802
(512) 406-6212
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1333940-07
—
TX
Enumeration date
12/30/2021
Last updated
12/30/2021
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