Provider Demographics
NPI:1750657920
Name:ADDICTION MEDICINE CONSULTANTS OF TEXAS, PLLC
Entity type:Organization
Organization Name:ADDICTION MEDICINE CONSULTANTS OF TEXAS, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:L
Authorized Official - Last Name:BUTTS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:512-426-8343
Mailing Address - Street 1:37131 INTERSTATE 10 W
Mailing Address - Street 2:SUITE 101
Mailing Address - City:BOERNE
Mailing Address - State:TX
Mailing Address - Zip Code:78006-8989
Mailing Address - Country:US
Mailing Address - Phone:512-577-8666
Mailing Address - Fax:
Practice Address - Street 1:37131 INTERSTATE 10 W
Practice Address - Street 2:SUITE 101
Practice Address - City:BOERNE
Practice Address - State:TX
Practice Address - Zip Code:78006-8989
Practice Address - Country:US
Practice Address - Phone:512-577-8666
Practice Address - Fax:830-255-4660
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-31
Last Update Date:2014-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX672526363L00000X
TXH7939207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1023287794OtherNPI