Provider Demographics
NPI:1962759241
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:BARRY
Authorized Official - Middle Name:
Authorized Official - Last Name:CLOAK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-534-1320
Mailing Address - Street 1:815 BRAZOS ST STE A
Mailing Address - Street 2:489
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2514
Mailing Address - Country:US
Mailing Address - Phone:512-534-1320
Mailing Address - Fax:
Practice Address - Street 1:815 BRAZOS ST STE A
Practice Address - Street 2:489
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2514
Practice Address - Country:US
Practice Address - Phone:512-534-1320
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-06
Last Update Date:2012-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLG3185207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty