Provider Demographics
NPI:1710196332
Name:NORTH AUSTIN FAMILY MEDICINE, PA
Entity type:Organization
Organization Name:NORTH AUSTIN FAMILY MEDICINE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:BANGSTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-338-5150
Mailing Address - Street 1:11671 JOLLYVILLE RD
Mailing Address - Street 2:SUITE 203
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-4139
Mailing Address - Country:US
Mailing Address - Phone:512-338-5150
Mailing Address - Fax:512-338-5155
Practice Address - Street 1:11671 JOLLYVILLE RD
Practice Address - Street 2:SUITE 203
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-4139
Practice Address - Country:US
Practice Address - Phone:512-338-5150
Practice Address - Fax:512-338-5155
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK7990207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8A2720OtherBCBS
TX00073RMedicare PIN
TX8A2720OtherBCBS