Basic Information
Provider Information
NPI: 1730571449
EntityType: 2
ReplacementNPI:  
OrganizationName: MEDSPRING OF TEXAS, PA
LastName:  
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Mailing Information
Address1: 2901 VIA FORTUNA
Address2: STE 600
City: AUSTIN
State: TX
PostalCode: 787467565
CountryCode: US
TelephoneNumber: 5127659003
FaxNumber: 5124857393
Practice Location
Address1: 7401 O' CONNOR DR
Address2:  
City: ROUND ROCK
State: TX
PostalCode: 786845509
CountryCode: US
TelephoneNumber: 5127924455
FaxNumber: 5124857393
Other Information
ProviderEnumerationDate: 03/04/2015
LastUpdateDate: 03/09/2015
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: KADERLI
AuthorizedOfficialFirstName: CHERYL
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: CONTRACTING MANAGER
AuthorizedOfficialTelephone: 5127659003
IsSoleProprietor:  
IsOrganizationSubpart: N
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NPICertificationDate:  

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

No ID Information.


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