=====================================================
General NPI Number Information
=====================================================
NPI Number | 1316947344
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | THOMAS R MCMINN MD
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/01/2005
-----------------------------------------------------
Last Update Date | 02/01/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3801 N LAMAR BLVD STE 300 AUSTIN HEART PA
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78756-4080
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-206-3600
-----------------------------------------------------
Fax | 512-454-2581
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7800 SHOAL CREEK BLVD STE 205N AUSTIN HEART
-----------------------------------------------------
City | AUSTIN
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 78757-1016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 512-206-4300
-----------------------------------------------------
Fax | 512-206-4350
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207RC0000X
-----------------------------------------------------
Taxonomy Name | Cardiovascular Disease Physician
-----------------------------------------------------
License Number | K6145
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 207RI0011X
-----------------------------------------------------
Taxonomy Name | Interventional Cardiology Physician
-----------------------------------------------------
License Number | K6145
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------