MEDICARE: UNION TREATMENT CENTERS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	111NX0100X	Occupational Health Chiropractor	DC6847	TX
2	207Q00000X	Family Medicine Physician	K6822	TX

General Provider Information

NPI Number	:	1073612594
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNION TREATMENT CENTERS

Provider Business Mailing Address
First Line	:	8900 SHOAL CREEK BLVD STE 200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78757-6853
Country	:	US
Telephone Number	:	512-323-6900
Fax Number	:	512-323-6903

Provider Business Practice Location Address
First Line	:	8900 SHOAL CREEK BLVD
Second Line	:	BLDG 200
City	:	AUSTIN
State	:	TX
Zip	:	78757-7591
Country	:	US
Telephone Number	:	512-323-6900
Fax Number	:	512-323-6903

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. CANDICE R RODRIGUEZ-AGUIRRE
Credential	:
Telephone Number	:	512-323-6900

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	11/05/2008

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