Provider Demographics
NPI:1972026706
Name:ORIENTAL MEDICINE ASSOCIATES
Entity Type:Organization
Organization Name:ORIENTAL MEDICINE ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:KATHRYN
Authorized Official - Last Name:TILLERY-KERR
Authorized Official - Suffix:
Authorized Official - Credentials:MACOM
Authorized Official - Phone:512-943-9885
Mailing Address - Street 1:1800 ROBB LN
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-3035
Mailing Address - Country:US
Mailing Address - Phone:512-657-0601
Mailing Address - Fax:
Practice Address - Street 1:212 W 10TH ST
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78626-5814
Practice Address - Country:US
Practice Address - Phone:512-943-9885
Practice Address - Fax:512-943-9885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-24
Last Update Date:2017-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01066171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty