Provider Demographics
NPI:1083806954
Name:AUSTIN SURGICAL ARTS
Entity type:Organization
Organization Name:AUSTIN SURGICAL ARTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:BUCHANAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, DDS, FACS
Authorized Official - Phone:512-366-7722
Mailing Address - Street 1:P.O. BOX 979
Mailing Address - Street 2:
Mailing Address - City:TAYLOR
Mailing Address - State:TX
Mailing Address - Zip Code:76574
Mailing Address - Country:US
Mailing Address - Phone:512-366-7722
Mailing Address - Fax:512-366-7499
Practice Address - Street 1:6012 W. WILLIAM CANNON
Practice Address - Street 2:B101
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749
Practice Address - Country:US
Practice Address - Phone:512-366-7722
Practice Address - Fax:512-366-7499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-15
Last Update Date:2016-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204E00000XAllopathic & Osteopathic PhysiciansOral & Maxillofacial SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00N85TOtherMEDICARE GROUP