Provider Demographics
NPI:1093264855
Name:MATTHEW F MCCARTY MD PLLC
Entity Type:Organization
Organization Name:MATTHEW F MCCARTY MD PLLC
Other - Org Name:BALCONES PAIN CONSULTANTS LAB
Other - Org Type:Other Name
Authorized Official - Title/Position:CHIEF ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LAURI
Authorized Official - Middle Name:
Authorized Official - Last Name:ROSE
Authorized Official - Suffix:
Authorized Official - Credentials:MBA, CASC
Authorized Official - Phone:512-600-6620
Mailing Address - Street 1:4544 S LAMAR BLVD
Mailing Address - Street 2:STE 700
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78745-1500
Mailing Address - Country:US
Mailing Address - Phone:512-834-4141
Mailing Address - Fax:512-834-4142
Practice Address - Street 1:4544 S LAMAR BLVD
Practice Address - Street 2:STE 700
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745-1500
Practice Address - Country:US
Practice Address - Phone:512-834-4141
Practice Address - Fax:512-834-4142
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-22
Last Update Date:2016-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX45D188237291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory