Provider Demographics
NPI: | 1508896804 |
---|---|
Name: | SETON/UT SOUTHWESTERN UNIVERSITY PHYSICIANS GROUP |
Entity Type: | Organization |
Organization Name: | SETON/UT SOUTHWESTERN UNIVERSITY PHYSICIANS GROUP |
Other - Org Name: | CTMF, INC. |
Other - Org Type: | Former Legal Business Name |
Authorized Official - Title/Position: | BILLING MANAGER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | MARIA |
Authorized Official - Middle Name: | L |
Authorized Official - Last Name: | HARVEY |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 512-324-8617 |
Mailing Address - Street 1: | 1601 RIO GRANDE |
Mailing Address - Street 2: | SUITE 415 |
Mailing Address - City: | AUSTIN |
Mailing Address - State: | TX |
Mailing Address - Zip Code: | 78701 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 512-324-8960 |
Mailing Address - Fax: | 512-324-8962 |
Practice Address - Street 1: | 601 E 15TH ST |
Practice Address - Street 2: | |
Practice Address - City: | AUSTIN |
Practice Address - State: | TX |
Practice Address - Zip Code: | 78701-1930 |
Practice Address - Country: | US |
Practice Address - Phone: | 512-324-8960 |
Practice Address - Fax: | 512-324-8960 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-07-03 |
Last Update Date: | 2013-02-18 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
No | 204C00000X | Allopathic & Osteopathic Physicians | Neuromusculoskeletal Medicine, Sports Medicine | Group - Multi-Specialty | |
No | 204E00000X | Allopathic & Osteopathic Physicians | Oral & Maxillofacial Surgery | Group - Multi-Specialty | |
No | 207K00000X | Allopathic & Osteopathic Physicians | Allergy & Immunology | Group - Multi-Specialty | |
No | 207N00000X | Allopathic & Osteopathic Physicians | Dermatology | Group - Multi-Specialty | |
No | 207P00000X | Allopathic & Osteopathic Physicians | Emergency Medicine | Group - Multi-Specialty | |
No | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207T00000X | Allopathic & Osteopathic Physicians | Neurological Surgery | Group - Multi-Specialty | |
No | 207V00000X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Group - Multi-Specialty | |
No | 207W00000X | Allopathic & Osteopathic Physicians | Ophthalmology | Group - Multi-Specialty | |
No | 207X00000X | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Group - Multi-Specialty | |
No | 208000000X | Allopathic & Osteopathic Physicians | Pediatrics | Group - Multi-Specialty | |
No | 2082S0099X | Allopathic & Osteopathic Physicians | Plastic Surgery | Plastic Surgery Within the Head and Neck | Group - Multi-Specialty |
No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
TX | 112872003 | Medicaid | |
TX | 0090H | Medicare ID - Type Unspecified | |
TX | 112872003 | Medicaid |