Provider Demographics
NPI:1629293279
Name:CENTRAL TEXAS ENT, LLP
Entity Type:Organization
Organization Name:CENTRAL TEXAS ENT, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:A
Authorized Official - Last Name:SALZER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:979-680-8808
Mailing Address - Street 1:2805 EARL RUDDER FWY S
Mailing Address - Street 2:
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77845-6080
Mailing Address - Country:US
Mailing Address - Phone:979-680-8808
Mailing Address - Fax:979-695-6517
Practice Address - Street 1:2805 EARL RUDDER FWY S
Practice Address - Street 2:
Practice Address - City:COLLEGE STATION
Practice Address - State:TX
Practice Address - Zip Code:77845-6080
Practice Address - Country:US
Practice Address - Phone:979-680-8808
Practice Address - Fax:979-695-6517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2008-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ5638174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX081199401Medicaid
TX0081BDMedicare ID - Type Unspecified