Provider Demographics
NPI:1063910842
Name:RUNNING WILD SEA, LLC
Entity type:Organization
Organization Name:RUNNING WILD SEA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LOANN
Authorized Official - Middle Name:
Authorized Official - Last Name:TRINH
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-944-4585
Mailing Address - Street 1:PO BOX 10414
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78766-1414
Mailing Address - Country:US
Mailing Address - Phone:512-944-4585
Mailing Address - Fax:
Practice Address - Street 1:8557 RESEARCH BLVD STE 128
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-7855
Practice Address - Country:US
Practice Address - Phone:512-836-7399
Practice Address - Fax:512-836-7399
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-01-26
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty