Provider Demographics
NPI:1477933851
Name:HILL COUNTRY INTEGRATIVE MEDICINE
Entity Type:Organization
Organization Name:HILL COUNTRY INTEGRATIVE MEDICINE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTA
Authorized Official - Middle Name:
Authorized Official - Last Name:O'LEARY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:830-998-0170
Mailing Address - Street 1:106 E MORSE ST
Mailing Address - Street 2:
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:TX
Mailing Address - Zip Code:78624-3926
Mailing Address - Country:US
Mailing Address - Phone:830-998-0170
Mailing Address - Fax:
Practice Address - Street 1:1603 E MAIN ST UNIT A
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:TX
Practice Address - Zip Code:78624-5450
Practice Address - Country:US
Practice Address - Phone:830-998-0170
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-01
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK5643207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1750326112OtherINDIVIDUAL NPI
TXTXB109563OtherMEDICARE PTAN