Provider Demographics
NPI:1821069014
Name:CENTRAL TEXAS MEDICAL SPECIALISTS PLLC
Entity Type:Organization
Organization Name:CENTRAL TEXAS MEDICAL SPECIALISTS PLLC
Other - Org Name:AUSTIN CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:REVENUE CYCLE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JANINE
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-505-5500
Mailing Address - Street 1:9715 BURNET RD
Mailing Address - Street 2:BLDG 7, STE 200
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5215
Mailing Address - Country:US
Mailing Address - Phone:512-505-5500
Mailing Address - Fax:512-585-8490
Practice Address - Street 1:9715 BURNET RD
Practice Address - Street 2:BLDG 7, STE 200
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5215
Practice Address - Country:US
Practice Address - Phone:512-505-5500
Practice Address - Fax:512-585-8490
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-27
Last Update Date:2017-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
No2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No2086X0206XAllopathic & Osteopathic PhysiciansSurgerySurgical OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX157895704Medicaid
2159693OtherPK
2159693OtherPK
157895701OtherTPI #
TX270798Medicare PIN