MEDICARE: PWN REMOTE CARE SERVICES, 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	208D00000X	General Practice Physician

General Provider Information

NPI Number	:	1861099723
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PWN REMOTE CARE SERVICES, PA

Provider Business Mailing Address
First Line	:	823 CONGRESS AVE STE 1200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-2402
Country	:	US
Telephone Number	:	888-362-4321
Fax Number	:

Provider Business Practice Location Address
First Line	:	823 CONGRESS AVE STE 1200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-2402
Country	:	US
Telephone Number	:	888-362-4321
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT, SECRETARY, AND TREASURER
Name	:	BRANTLEY TILMAN JOLLY
Credential	:	MD
Telephone Number	:	888-362-4321

Provider Enumeration Date	:	10/05/2020
Last Update Date	:	02/16/2023

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