Organization
AUSTIN GASTROENTEROLOGY PA
Active
Parent organization
AUSTIN GASTROENTEROLOGY PA
Other names
AUSTIN GASTROENTEROLOGY LAB
Organization subpart
Yes
Provider details
NPI number
Legal business name
AUSTIN GASTROENTEROLOGY PA
Authorized official
DR. BRUCE A LEVY MD, JD (CEO)
(512) 485-5879
Entity
Organization
Contact information
Practice address
8015 SHOAL CREEK BLVD STE 116, AUSTIN, TX 78757-8051
(512) 420-0186
(512) 420-0397
Mailing address
8015 SHOAL CREEK BLVD STE 116, AUSTIN, TX 78757-8051
(512) 420-0186
(512) 420-0397
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D1056054
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
45D1056054
CMS CLIA
TX
Enumeration date
11/01/2006
Last updated
02/24/2014
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