MEDICARE: MEDICAL PRACTICE MANAGEMENT-LLC

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	363A00000X	Physician Assistant	672526	TX

General Provider Information

NPI Number	:	1538445127
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAL PRACTICE MANAGEMENT-LLC

Provider Business Mailing Address
First Line	:	7005 MIRA LOMA LN
Second Line	:	STE 100
City	:	AUSTIN
State	:	TX
Zip	:	78723-1411
Country	:	US
Telephone Number	:	512-796-8416
Fax Number	:

Provider Business Practice Location Address
First Line	:	7005 MIRA LOMA LN
Second Line	:	STE 100
City	:	AUSTIN
State	:	TX
Zip	:	78723-1411
Country	:	US
Telephone Number	:	512-796-8416
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	BRIAN HINOJOSA
Credential	:
Telephone Number	:	512-796-8416

Provider Enumeration Date	:	10/26/2011
Last Update Date	:	03/02/2013

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