Provider Demographics
NPI:1598877920
Name:BUTTERCUP CREEK FAMILY MEDICINE PA
Entity Type:Organization
Organization Name:BUTTERCUP CREEK FAMILY MEDICINE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:HATHCOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-249-1400
Mailing Address - Street 1:200 BUTTERCUP CREEK BLVD
Mailing Address - Street 2:STE 115
Mailing Address - City:CEDAR PARK
Mailing Address - State:TX
Mailing Address - Zip Code:78613
Mailing Address - Country:US
Mailing Address - Phone:512-249-1400
Mailing Address - Fax:512-249-1800
Practice Address - Street 1:200 BUTTERCUP CREEK BLVD
Practice Address - Street 2:STE 115
Practice Address - City:CEDAR PARK
Practice Address - State:TX
Practice Address - Zip Code:78613
Practice Address - Country:US
Practice Address - Phone:512-249-1400
Practice Address - Fax:512-249-1800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH1869207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000110J7Medicaid
TX00468XMedicare ID - Type UnspecifiedGROUP NUMBER
TX8C6775Medicare ID - Type Unspecified
G29111Medicare UPIN