Provider Demographics
NPI:1083679294
Name:CENTRAL TEXAS MEDICAL ASSOCIATES
Entity Type:Organization
Organization Name:CENTRAL TEXAS MEDICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:GAY
Authorized Official - Last Name:ELDRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-353-0744
Mailing Address - Street 1:2005 MEDICAL PKWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-7576
Mailing Address - Country:US
Mailing Address - Phone:512-753-3756
Mailing Address - Fax:512-353-0807
Practice Address - Street 1:2005 MEDICAL PKWY
Practice Address - Street 2:SUITE C
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-7576
Practice Address - Country:US
Practice Address - Phone:512-396-3911
Practice Address - Fax:512-353-0807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-19
Last Update Date:2011-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXD0168207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX114603702Medicaid
TX00R393Medicare PIN
TX00R39RMedicare PIN
TX00R393RMedicare PIN
TX82X254Medicare ID - Type Unspecified
TX114603702Medicaid