Healthcare Provider Details

I. General information

NPI: 1407092166
Provider Name (Legal Business Name): MEDICINE IN MOTION, MARTHA PYRON MD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2008
Last Update Date: 04/25/2022
Certification Date: 04/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 W 38TH ST STE G4
AUSTIN TX
78705-1134
US

IV. Provider business mailing address

305 W 55TH ST
AUSTIN TX
78751-1101
US

V. Phone/Fax

Practice location:
  • Phone: 512-257-2500
  • Fax:
Mailing address:
  • Phone: 512-257-2500
  • Fax: 512-257-2504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberK9877
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: MARTHA I PYRON
Title or Position: PHYSICIAN PRESIDENT
Credential: MD
Phone: 512-257-2500