Provider Demographics
NPI:1952820599
Name:TMC PROVIDER GROUP, PLLC
Entity Type:Organization
Organization Name:TMC PROVIDER GROUP, PLLC
Other - Org Name:TEXAS MEDCLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ERICA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAUSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:312-590-5372
Mailing Address - Street 1:PO BOX 4165
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97208-4165
Mailing Address - Country:US
Mailing Address - Phone:210-349-5577
Mailing Address - Fax:
Practice Address - Street 1:1922 S. STATE HWY 46
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78216
Practice Address - Country:US
Practice Address - Phone:210-349-5577
Practice Address - Fax:210-491-2868
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TMC PROVIDER GROUP, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-09-14
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF0031174400000X
261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1053784660OtherURGENT CARE