MEDICARE: MEDSPRING OF TEXAS, PA

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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1255722120
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDSPRING OF TEXAS, PA

Provider Business Mailing Address
First Line	:	2901 VIA FORTUNA
Second Line	:	STE 600
City	:	AUSTIN
State	:	TX
Zip	:	78746-7565
Country	:	US
Telephone Number	:	512-765-9003
Fax Number	:	512-410-6533

Provider Business Practice Location Address
First Line	:	3301 N ASHLAND AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60657-2127
Country	:	US
Telephone Number	:	312-429-5752
Fax Number	:	512-485-7393

Authorized Official
Title or Position	:	CONTRACTING MANAGER
Name	:	CHERYL KADERLI
Credential	:
Telephone Number	:	512-765-9003

Provider Enumeration Date	:	02/12/2015
Last Update Date	:	02/12/2015

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