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	261QU0200X	Urgent Care Clinic/Center

General Provider Information

NPI Number	:	1891516720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TMC PROVIDER GROUP PLLC

Provider Business Mailing Address
First Line	:	600 JEFFERSON ST STE 600
Second Line	:
City	:	LAFAYETTE
State	:	LA
Zip	:	70501-6987
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	164 BELTERRA VILLAGE WAY # X200
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78737-4794
Country	:	US
Telephone Number	:	512-596-0595
Fax Number	:

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

Provider Enumeration Date	:	10/23/2024
Last Update Date	:	02/26/2025

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