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NPI Code Detail

MEDICARE: BLUE LOTUS MEDICAL GROUP LLC

MEDICARE: BLUE LOTUS MEDICAL GROUP 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
1363LA2200XAdult Health Nurse Practitioner
2207RG0300XGeriatric Medicine (Internal Medicine) Physician

General Provider Information

NPI Number : 1578309852
Entity Type Code : Organization
Provider Name (Legal Business Name) : BLUE LOTUS MEDICAL GROUP LLC
Provider Business Mailing Address
First Line : 7600 CHEVY CHASE DR STE 300
Second Line :
City : AUSTIN
State : TX
Zip : 78752-1599
Country : US
Telephone Number : 817-910-6711
Fax Number : 800-915-0474
Provider Business Practice Location Address
First Line : 7600 CHEVY CHASE DR STE 300
Second Line :
City : AUSTIN
State : TX
Zip : 78752-1599
Country : US
Telephone Number : 817-910-6711
Fax Number : 800-915-0474
Authorized Official
Title or Position : CEO
Name : DAVID MCCLURE
Credential :
Telephone Number : 817-682-0341
Provider Enumeration Date : 07/05/2024
Last Update Date : 02/19/2026

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