Basic Information
| Provider Information | |||||||||
| NPI: | 1952326993 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | HILL COUNTRY MEDICAL ASSOCIATES | ||||||||
| LastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 774 LANDA ST | ||||||||
| Address2: | |||||||||
| City: | NEW BRAUNFELS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781306114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306250305 | ||||||||
| FaxNumber: | 8306252693 | ||||||||
| Practice Location | |||||||||
| Address1: | 774 LANDA ST | ||||||||
| Address2: | |||||||||
| City: | NEW BRAUNFELS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 781306114 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8306250305 | ||||||||
| FaxNumber: | 8306252693 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/12/2006 | ||||||||
| LastUpdateDate: | 10/09/2007 | ||||||||
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| AuthorizedOfficialLastName: | BRANDSMA | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 8302213210 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 00R38T | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER |