Healthcare Provider Details

I. General information

NPI: 1346909231
Provider Name (Legal Business Name): WHITE COAT MEDICAL, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2021
Last Update Date: 08/24/2022
Certification Date: 08/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

180 TOWN CENTER BLVD STE 400
JARRELL TX
76537-4007
US

IV. Provider business mailing address

180 TOWN CENTER BLVD STE 400
JARRELL TX
76537-4007
US

V. Phone/Fax

Practice location:
  • Phone: 512-850-9143
  • Fax: 512-287-5582
Mailing address:
  • Phone: 512-850-9143
  • Fax: 512-287-5582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: RAMIRO ABRAHAM PENA
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 512-588-1501