Provider Demographics
NPI:1679574685
Name:RON MANSOLO MD PA
Entity Type:Organization
Organization Name:RON MANSOLO MD PA
Other - Org Name:LEANDER PRIMARY CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:G
Authorized Official - Last Name:PASSONS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-968-7570
Mailing Address - Street 1:902 CRYSTAL FALLS PKWY
Mailing Address - Street 2:
Mailing Address - City:LEANDER
Mailing Address - State:TX
Mailing Address - Zip Code:78641-3646
Mailing Address - Country:US
Mailing Address - Phone:512-259-2222
Mailing Address - Fax:512-259-2290
Practice Address - Street 1:902 CRYSTAL FALLS PKWY
Practice Address - Street 2:
Practice Address - City:LEANDER
Practice Address - State:TX
Practice Address - Zip Code:78641-3646
Practice Address - Country:US
Practice Address - Phone:512-259-2222
Practice Address - Fax:512-259-2290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-02
Last Update Date:2011-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0039GHOtherBLUE CROSS BLUE SHIELD
TX0039GHOtherBLUE CROSS BLUE SHIELD