Healthcare Provider Details

I. General information

NPI: 1104377860
Provider Name (Legal Business Name): U.S. HEALTHWORKS MEDICAL GROUP OF TEXAS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/18/2016
Last Update Date: 10/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 W ANDERSON LN
AUSTIN TX
78757-1220
US

IV. Provider business mailing address

PO BOX 404974
ATLANTA GA
30384-4974
US

V. Phone/Fax

Practice location:
  • Phone: 512-459-4367
  • Fax: 512-459-8353
Mailing address:
  • Phone: 888-499-4284
  • Fax: 678-942-2076

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOSEPH T MALLAS
Title or Position: PRESIDENT & CHEIF EXECUTIVE OFFICER
Credential:
Phone: 661-678-2600