Basic Information
| Provider Information | |||||||||
| NPI: | 1356871347 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MEDSPRING OF TEXAS, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3711 S MOPAC EXPY | ||||||||
| Address2: | BLDG 2 STE 400 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78746 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 5131 S. CUSTER ROAD | ||||||||
| Address2: | #111 | ||||||||
| City: | MCKINNEY | ||||||||
| State: | TX | ||||||||
| PostalCode: | 75070 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8889800505 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/13/2017 | ||||||||
| LastUpdateDate: | 03/17/2018 | ||||||||
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| AuthorizedOfficialLastName: | CORBETT | ||||||||
| AuthorizedOfficialFirstName: | MIND | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING AND SUPPORT OPS MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5128610322 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QU0200X | Y | Ambulatory Health Care Facilities | Clinic/Center | Urgent Care |
ID Information
| ID | Type | State | Issuer | Description | 349960001 | 05 | TX | MEDICAID |