Provider Demographics
NPI:1043967276
Name:RELIANT MD MEDICAL ASSOCIATES PLLC
Entity Type:Organization
Organization Name:RELIANT MD MEDICAL ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER, RELIANT IMMUNE DIAGNOSTICS
Authorized Official - Prefix:MRS
Authorized Official - First Name:TANYEA
Authorized Official - Middle Name:
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-350-7122
Mailing Address - Street 1:6500 RIVER PLACE BLVD STE 4-102
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78730-1109
Mailing Address - Country:US
Mailing Address - Phone:512-229-9898
Mailing Address - Fax:
Practice Address - Street 1:6500 RIVER PLACE BLVD STE 4-102
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78730-1109
Practice Address - Country:US
Practice Address - Phone:512-229-9898
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-08
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1K7179Medicaid