Provider Demographics
NPI:1699878801
Name:GREATER AUSTIN NEUROLOGY CLINIC PA
Entity type:Organization
Organization Name:GREATER AUSTIN NEUROLOGY CLINIC PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:MUNIR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-228-3800
Mailing Address - Street 1:13915 N MO PAC EXPY
Mailing Address - Street 2:SUITE 302
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78728-6517
Mailing Address - Country:US
Mailing Address - Phone:512-228-3800
Mailing Address - Fax:512-228-3801
Practice Address - Street 1:13915 N MO PAC EXPY
Practice Address - Street 2:SUITE 302
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78728-6517
Practice Address - Country:US
Practice Address - Phone:512-228-3800
Practice Address - Fax:512-228-3801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL65382084N0400X, 2084N0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084N0600XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyClinical NeurophysiologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DD5916OtherRAIL ROAD MEDICARE
602284200OtherUS DEPT OF LABOR
0097KKOtherBLUE CROSS
TX163332301Medicaid
602284200OtherUS DEPT OF LABOR
DD5916OtherRAIL ROAD MEDICARE
H94319Medicare UPIN