MEDICARE: VMD PRIMARY PROVIDERS OF SOUTH CENTRAL TEXAS PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	363L00000X	Nurse Practitioner
2	207R00000X	Internal Medicine Physician
3	363A00000X	Physician Assistant
4	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1790318566
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VMD PRIMARY PROVIDERS OF SOUTH CENTRAL TEXAS PLLC

Provider Business Mailing Address
First Line	:	PO BOX 28011
Second Line	:
City	:	BELFAST
State	:	ME
Zip	:	04915-2032
Country	:	US
Telephone Number	:	512-988-5355
Fax Number	:	512-323-0307

Provider Business Practice Location Address
First Line	:	720 W 34TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78705-1205
Country	:	US
Telephone Number	:	512-988-5355
Fax Number	:	512-323-0307

Authorized Official
Title or Position	:	DIRECTOR REVENUE CYCLE
Name	:	REBECCA RAGER
Credential	:
Telephone Number	:	844-969-0686

Provider Enumeration Date	:	02/19/2020
Last Update Date	:	03/23/2026

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