Provider Demographics
NPI:1518061092
Name:ORTHOPAEDIC ASSOCIATES OF CENTRAL TX, PA
Entity Type:Organization
Organization Name:ORTHOPAEDIC ASSOCIATES OF CENTRAL TX, PA
Other - Org Name:ROUND ROCK ORTHOPAEDICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:TOM
Authorized Official - Middle Name:J
Authorized Official - Last Name:MCVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-744-6414
Mailing Address - Street 1:16020 PARK VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-3573
Mailing Address - Country:US
Mailing Address - Phone:512-244-0766
Mailing Address - Fax:512-244-1013
Practice Address - Street 1:16020 PARK VALLEY DR
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-3573
Practice Address - Country:US
Practice Address - Phone:512-244-0766
Practice Address - Fax:512-244-1013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-12
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX085506601Medicaid
TX0273210001Medicare NSC
TX00TS86Medicare PIN