Provider Demographics
NPI:1386770675
Name:BRYAN AUSTIN
Entity type:Organization
Organization Name:BRYAN AUSTIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DME
Authorized Official - Phone:214-902-0040
Mailing Address - Street 1:PO BOX 3609
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75106-3609
Mailing Address - Country:US
Mailing Address - Phone:214-902-0040
Mailing Address - Fax:214-902-0220
Practice Address - Street 1:2639 WALNUT HILL LN
Practice Address - Street 2:SUITE#103
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75229-5640
Practice Address - Country:US
Practice Address - Phone:214-902-0040
Practice Address - Fax:214-902-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2010-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170215101Medicaid
TX170215103Medicaid
TX170215102Medicaid
TX170215102Medicaid