Healthcare Provider Details

I. General information

NPI: 1124250410
Provider Name (Legal Business Name): CENTRAL TEXAS MEDICAL SPECIALISTS PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2009
Last Update Date: 05/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9715 BURNET RD BLD 7 STE 200
AUSTIN TX
78758-5215
US

IV. Provider business mailing address

9715 BURNET RD BLD 7 STE 200
AUSTIN TX
78758-5215
US

V. Phone/Fax

Practice location:
  • Phone: 512-334-2866
  • Fax: 512-334-2702
Mailing address:
  • Phone: 512-334-2866
  • Fax: 512-334-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. JANINE RICCI
Title or Position: REVENUE CYCLE DIRECTOR
Credential:
Phone: 512-334-2654