Provider Demographics
NPI:1487890620
Name:AUSTIN VASCULAR INSTITUTE PA
Entity type:Organization
Organization Name:AUSTIN VASCULAR INSTITUTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:BRENNIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-346-8346
Mailing Address - Street 1:7000 NORTH MOPAC EXPRESSWAY
Mailing Address - Street 2:SUITE 320
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-3258
Mailing Address - Country:US
Mailing Address - Phone:512-346-8346
Mailing Address - Fax:512-346-8343
Practice Address - Street 1:7000 NORTH MOPAC EXPRESSWAY
Practice Address - Street 2:SUITE 320
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-3258
Practice Address - Country:US
Practice Address - Phone:512-346-8346
Practice Address - Fax:512-346-8343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-17
Last Update Date:2009-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2086S0129X, 208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0063RZOtherBCBS
TX0063RZOtherBCBS