Provider Demographics
NPI:1023287976
Name:CAPITAL AREA PRIMARY CARE, PLLC
Entity type:Organization
Organization Name:CAPITAL AREA PRIMARY CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:C
Authorized Official - Last Name:REBOK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-708-9700
Mailing Address - Street 1:98 SAN JACINTO BLVD
Mailing Address - Street 2:STE. 1800
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-4082
Mailing Address - Country:US
Mailing Address - Phone:512-708-9700
Mailing Address - Fax:
Practice Address - Street 1:2900 N QUINLAN PARK RD
Practice Address - Street 2:SUITE 430
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78732-6083
Practice Address - Country:US
Practice Address - Phone:512-266-8877
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-25
Last Update Date:2011-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200927601Medicaid
TX203436501Medicaid
TX203436502Medicaid
TX200927602Medicaid
TX00Z736Medicare PIN
TX203436502Medicaid