Organization
AUSTIN DIAGNOSTIC CLINIC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINA SHANNON (CREDENTIALING SPECIALIST)
(512) 901-4937
Entity
Organization
Contact information
Practice address
12221 N MOPAC EXPY, AUSTIN, TX 78758-2401
(512) 901-4009
(512) 901-3909
Mailing address
12221 N MOPAC EXPY, AUSTIN, TX 78758-2401
(512) 901-4937
(512) 901-3945
Taxonomy
Speciality
Code
Description
License number
State
208M00000X
Hospitalist Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1073591202
—
TX
Enumeration date
01/17/2018
Last updated
01/25/2018
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