Provider Demographics
NPI:1215336375
Name:AUSTIN INTEGRATED MEDICAL GROUP PA
Entity type:Organization
Organization Name:AUSTIN INTEGRATED MEDICAL GROUP PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:FLUITT
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-442-2727
Mailing Address - Street 1:4316 JAMES CASEY ST
Mailing Address - Street 2:BLG B STE 201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1116
Mailing Address - Country:US
Mailing Address - Phone:512-442-2727
Mailing Address - Fax:
Practice Address - Street 1:4316 JAMES CASEY ST
Practice Address - Street 2:BLG B STE 201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1116
Practice Address - Country:US
Practice Address - Phone:512-442-2727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX08815111NR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty