| |
1210 W. Braker Lane Austin TX 78758 | |
(512) 978-9300 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 1210 W. Braker Lane, Austin, Texas |
Authorized Official Name and Position | Carolyn Konecny (CFO) |
Authorized Official Contact | 5129789000 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 17366 Austin TX 78760-7366 Ph: () - | 1210 W. Braker Lane Austin TX 78758 Ph: (512) 978-9300 |
NPI Number | 1720350978 |
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Provider Enumeration Date | 02/03/2012 |
Last Update Date | 08/13/2015 |
Medicare PECOS PAC ID | 5395802151 |
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Medicare Enrollment ID | O20120410000257 |
Identifier | Type | State | Issuer |
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1720350978 | NPI | - | NPPES |
2894107-01 | Medicaid | TX |
Taxonomy | Type | License (State) | Status |
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261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | (* (Not Available)) | Primary |
Harold D Lewis Do Pa Primary Care Clinic Medicare: Not Enrolled in Medicare Practice Location: 1901 West William Cannon Drive, Suite 123, Austin, TX 78745 Phone: 512-444-2661 Fax: 512-444-2720 | |
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