Provider Demographics
NPI:1336496595
Name:AUSTIN MED GROUP INC
Entity type:Organization
Organization Name:AUSTIN MED GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEEK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-461-2130
Mailing Address - Street 1:345 N RIVERVIEW ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-4200
Mailing Address - Country:US
Mailing Address - Phone:913-461-2130
Mailing Address - Fax:
Practice Address - Street 1:345 N RIVERVIEW ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-4200
Practice Address - Country:US
Practice Address - Phone:913-461-2130
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS12-41560207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Single Specialty