Basic Information
Provider Information
NPI: 1679934467
EntityType: 2
ReplacementNPI:  
OrganizationName: MEDSPRING OF TEXAS, PA
LastName:  
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Credential:  
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Mailing Information
Address1: 3711 S. MOPAC EXPRESSWAY
Address2: BLDG. 2 STE 400
City: AUSTIN
State: TX
PostalCode: 787468014
CountryCode: US
TelephoneNumber: 8889800505
FaxNumber:  
Practice Location
Address1: 2404 MCKINNEY AVE
Address2:  
City: DALLAS
State: TX
PostalCode: 752011936
CountryCode: US
TelephoneNumber: 8889800505
FaxNumber:  
Other Information
ProviderEnumerationDate: 03/08/2016
LastUpdateDate: 06/24/2016
NPIDeactivationReasonCode:  
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NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BELSHER
AuthorizedOfficialFirstName: JON
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CMO
AuthorizedOfficialTelephone: 5125511368
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
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AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QU0200X  Y Ambulatory Health Care FacilitiesClinic/CenterUrgent Care

No ID Information.


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