Medermis Laser Clinic

Primary specialty

Point of ServiceTaxonomy code 305S00000X

Legal business name

MEDERMIS LASER CLINIC

Practice address

2111 Dickson Dr
Suite 20
Austin, TX 78704-4796

Phone

(512) 637-5277

NPI assigned

Jan 31, 2011

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Mike Livermore

Title

Ceo

Phone

(512) 965-8189

Specialties & licenses 1

Addresses

Other names 1

• Tattoo Removal Doing business as

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1296432000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1296432000000",
    "number": "1669778171",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2111 DICKSON DR",
            "address_2": "SUITE 20",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787044796",
            "telephone_number": "512-637-5277"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2111 DICKSON DR",
            "address_2": "SUITE 20",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787044796",
            "telephone_number": "512-637-5277"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MEDERMIS LASER CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-01-31",
        "last_updated": "2011-01-31",
        "status": "A",
        "authorized_official_last_name": "LIVERMORE",
        "authorized_official_first_name": "MIKE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "512-965-8189",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "305S00000X",
            "taxonomy_group": "",
            "desc": "Point of Service",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Tattoo Removal",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Med Southwest, PLLC
• Med Southwest, PLLC
• Med2You, LLC
• Rachel Laura Medbery, M.D.
• Medco Respiratory Instruments, Inc
• Charles Maxwell Medert, MD
• Cydney McDonald Medford, MS CCC SLP
• Rex E. Medford, MD
• Medfusion Lab LLC
• Medfusion Supplies Inc

• Point of Service in Austin, TX
• Providers in Austin, TX by specialty
• Point of Service in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.