Provider Demographics
NPI:1104095470
Name:UNIVERSITY OF TEXAS AT AUSTIN
Entity type:Organization
Organization Name:UNIVERSITY OF TEXAS AT AUSTIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:CHAMPAGNEMILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-475-8231
Mailing Address - Street 1:PO BOX 7339
Mailing Address - Street 2:UNIVERSITY OF TEXAS AT AUSTIN
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78713-7339
Mailing Address - Country:US
Mailing Address - Phone:512-475-8231
Mailing Address - Fax:512-471-0680
Practice Address - Street 1:100 W DEAN KEETON
Practice Address - Street 2:UNIVERSITY HEALTH SERVICES
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705
Practice Address - Country:US
Practice Address - Phone:512-475-8231
Practice Address - Fax:512-471-0680
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-21
Last Update Date:2008-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service