MEDICARE: ROUND ROCK MENTAL HEALTH 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	363AM0700X	Medical Physician Assistant
2	2084P0800X	Psychiatry Physician	M3334	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1538338306
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROUND ROCK MENTAL HEALTH PA

Provider Business Mailing Address
First Line	:	1717 N IH 35 STE 200
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-2901
Country	:	US
Telephone Number	:	512-964-6992
Fax Number	:	512-388-0373

Provider Business Practice Location Address
First Line	:	1717 N IH 35 STE 200
Second Line	:
City	:	ROUND ROCK
State	:	TX
Zip	:	78664-2901
Country	:	US
Telephone Number	:	512-964-6992
Fax Number	:	512-388-0373

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MICHAEL ANDREW MUSGROVE
Credential	:	M.D.
Telephone Number	:	512-964-6992

Provider Enumeration Date	:	02/26/2008
Last Update Date	:	05/20/2020

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Directions to “ROUND ROCK MENTAL HEALTH PA ” Practice Location

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