Provider Demographics
NPI:1386049419
Name:LINDA L AUSTIN, MD PC
Entity type:Organization
Organization Name:LINDA L AUSTIN, MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:L
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:602-254-2200
Mailing Address - Street 1:1301 E MCDOWELL RD STE 103
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2605
Mailing Address - Country:US
Mailing Address - Phone:602-254-2200
Mailing Address - Fax:602-254-9337
Practice Address - Street 1:1301 E MCDOWELL RD STE 103
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2605
Practice Address - Country:US
Practice Address - Phone:602-254-2200
Practice Address - Fax:602-254-9337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ21319302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZMD21329OtherPRIVIDER STATE LICENSE NO.
AZ146028001Medicaid
AZ146028001Medicaid
AZF65881Medicare UPIN