Provider Demographics
NPI:1679528582
Name:CAPITAL MEDICAL CLINIC, LLP
Entity Type:Organization
Organization Name:CAPITAL MEDICAL CLINIC, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:HAGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-454-5171
Mailing Address - Street 1:1004 W 32ND ST
Mailing Address - Street 2:STE 400
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78705-1915
Mailing Address - Country:US
Mailing Address - Phone:512-454-5171
Mailing Address - Fax:
Practice Address - Street 1:1004 W 32ND ST
Practice Address - Street 2:STE 400
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1915
Practice Address - Country:US
Practice Address - Phone:512-454-5171
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-23
Last Update Date:2022-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093718701Medicaid
TXC18057Medicare UPIN
TXG67925Medicare UPIN
WIB54542Medicare UPIN
TXC23764Medicare UPIN
TXD47910Medicare UPIN
TXF88218Medicare UPIN
TX00E779Medicare PIN
TXC18799Medicare UPIN
TXG73557Medicare UPIN
TXH59977Medicare UPIN
TXB54542Medicare UPIN
TX093718701Medicaid
TXC14396Medicare UPIN
TXCO9079Medicare PIN
TXC16350Medicare UPIN