MEDICARE: MARY JO HART PA-C

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	PA03126	TX
2	363A00000X	Physician Assistant	PA03126	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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1760485932
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARY JO HART PA-C

Provider Business Mailing Address
First Line	:	2501 W WILLIAM CANNON DR
Second Line	:	SUITE 401
City	:	AUSTIN
State	:	TX
Zip	:	78745-5253
Country	:	US
Telephone Number	:	512-416-7246
Fax Number	:	512-275-2833

Provider Business Practice Location Address
First Line	:	3201 S AUSTIN AVE
Second Line	:	SUITE 265
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-7545
Country	:	US
Telephone Number	:	512-416-7246
Fax Number	:	512-275-2833

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	06/14/2017

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Directions to “ MARY JO HART PA-C” Practice Location

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