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NPI Code Detail

MEDICARE: 360 MEDICAL GROUP TEXAS PC

MEDICARE: 360 MEDICAL GROUP TEXAS PC
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
1208D00000XGeneral Practice Physician

General Provider Information

NPI Number : 1164354361
Entity Type Code : Organization
Provider Name (Legal Business Name) : 360 MEDICAL GROUP TEXAS PC
Provider Business Mailing Address
First Line : 5900 BALCONES DR STE 100
Second Line :
City : AUSTIN
State : TX
Zip : 78731-4298
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5900 BALCONES DR STE 100
Second Line :
City : AUSTIN
State : TX
Zip : 78731-4298
Country : US
Telephone Number : 773-645-1192
Fax Number :
Authorized Official
Title or Position : ADMINISTRATOR
Name : JAMES VILLAR
Credential :
Telephone Number : 773-645-1192
Provider Enumeration Date : 06/01/2026
Last Update Date : 06/01/2026

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Directions to “360 MEDICAL GROUP TEXAS PC ” Practice Location

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