Healthcare Provider Details

I. General information

NPI: 1295813764
Provider Name (Legal Business Name): CENTRAL RIVER HEALTHCARE GROUP, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1918 E RIVERSIDE DR SOUTH AUSTIN MEDICAL & HEALTH CLINIC
AUSTIN TX
78741-1323
US

IV. Provider business mailing address

8557 RESEARCH BLVD STE 128
AUSTIN TX
78758-7855
US

V. Phone/Fax

Practice location:
  • Phone: 512-326-9200
  • Fax:
Mailing address:
  • Phone: 512-326-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM7463
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberM5120
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberH4396
License Number StateTX
# 4
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberM2793
License Number StateTX
# 5
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number8016
License Number StateTX
# 6
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberL1765
License Number StateTX
# 7
Primary TaxonomyN
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License NumberL1765
License Number StateTX
# 8
Primary TaxonomyY
Taxonomy Code207PS0010X
TaxonomySports Medicine (Emergency Medicine) Physician
License NumberL1765
License Number StateTX

VIII. Authorized Official

Name: LOANN THE TRINH
Title or Position: PRESIDENT/MEDICAL DIRECTOR
Credential: D.O.
Phone: 512-326-9200