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General NPI Number Information
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NPI Number | 1538610274
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Entity Type | Organization
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Legal Business Name | ROCKDALE BLACKHAWK, LLC
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Dates
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Enumeration Date | 10/18/2016
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Last Update Date | 10/18/2016
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Provider Practice Location Address
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Address Line | 2200 PARK BEND DR BLDG 2-301
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City | AUSTIN
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State | TX
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Zip | 78758-5387
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Country | US
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Telephone | 512-351-3919
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Fax |
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Provider Business Mailing Address
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Address Line | 1 CHISHOLM TRL SUITE 400
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City | ROUND ROCK
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State | TX
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Zip | 78681-5008
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Country | US
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Telephone | 512-481-7060
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JEFFREY P MADISON
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Credential |
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Telephone | 512-446-4500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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