MEDICARE: TMC PROVIDER GROUP PLLC

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	207Q00000X	Family Medicine Physician	F0031	TX
2	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1598120388
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TMC PROVIDER GROUP PLLC

Provider Business Mailing Address
First Line	:	PO BOX 4165
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97208-4165
Country	:	US
Telephone Number	:	210-349-5577
Fax Number	:

Provider Business Practice Location Address
First Line	:	1007 NE LOOP 410
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78209-1205
Country	:	US
Telephone Number	:	210-821-5598
Fax Number	:	210-829-0125

Authorized Official
Title or Position	:	PRESIDENT
Name	:	ERICA HAUSER
Credential	:
Telephone Number	:	312-590-5372

Provider Enumeration Date	:	12/21/2015
Last Update Date	:	03/21/2023

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Directions to “TMC PROVIDER GROUP PLLC ” Practice Location

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