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8000 Anderson Sq Ste 113 Austin TX 78757-8482 | |
(512) 963-3372 | |
(512) 233-0721 |
Full Name | |
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Speciality | Clinic/Center |
Location | 8000 Anderson Sq Ste 113, Austin, Texas |
Authorized Official Name and Position | Roya Azadi (PHYSICIAN) |
Authorized Official Contact | 5129633346 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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8000 Anderson Sq Ste 113 Austin TX 78757-8482 Ph: (512) 338-0171 | 8000 Anderson Sq Ste 113 Austin TX 78757-8482 Ph: (512) 963-3372 |
NPI Number | 1023287158 |
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Provider Enumeration Date | 02/22/2008 |
Last Update Date | 11/22/2019 |
Medicare PECOS PAC ID | 4587992144 |
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Medicare Enrollment ID | O20190821002050 |
Identifier | Type | State | Issuer |
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1023287158 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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261Q00000X | Clinic/center | (* (Not Available)) | Primary |
Provider Name | Roya A Azadi |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1912180084 PECOS PAC ID: 6901790476 Enrollment ID: I20190821002559 |
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