Provider Demographics
NPI:1063428472
Name:AUSTIN COMPUTER DIAGNOSTICS, LTD.
Entity type:Organization
Organization Name:AUSTIN COMPUTER DIAGNOSTICS, LTD.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-454-9598
Mailing Address - Street 1:PO BOX 301749
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-0030
Mailing Address - Country:US
Mailing Address - Phone:512-454-9597
Mailing Address - Fax:512-380-0295
Practice Address - Street 1:711 W 38TH ST
Practice Address - Street 2:STE B-7
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1121
Practice Address - Country:US
Practice Address - Phone:512-454-9597
Practice Address - Fax:512-380-0295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-31
Last Update Date:2015-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXR11609261QR0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0200XAmbulatory Health Care FacilitiesClinic/CenterRadiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170399302Medicaid
TX470000611OtherRAILROAD MEDICARE
TX470000611OtherRAILROAD MEDICARE
TX170399302Medicaid