Provider Demographics
NPI:1407865355
Name:TEXAS SPORTS & FAMILY MEDICINE, PLLC
Entity Type:Organization
Organization Name:TEXAS SPORTS & FAMILY MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:C.
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:CHASSAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-473-0201
Mailing Address - Street 1:3200 RED RIVER ST
Mailing Address - Street 2:201
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-2655
Mailing Address - Country:US
Mailing Address - Phone:512-473-0201
Mailing Address - Fax:512-473-0202
Practice Address - Street 1:3200 RED RIVER ST
Practice Address - Street 2:201
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-2655
Practice Address - Country:US
Practice Address - Phone:512-473-0201
Practice Address - Fax:512-473-0202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Multi-Specialty