Provider Demographics
NPI:1841265915
Name:PHYSICIANS CENTER PA
Entity type:Organization
Organization Name:PHYSICIANS CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:MALE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:512-869-7310
Mailing Address - Street 1:3721 WILLIAMS DR
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-2401
Mailing Address - Country:US
Mailing Address - Phone:512-869-7310
Mailing Address - Fax:512-869-5616
Practice Address - Street 1:3721 WILLIAMS DR
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-2401
Practice Address - Country:US
Practice Address - Phone:512-869-7310
Practice Address - Fax:512-869-5616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-21
Last Update Date:2010-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH8460207Q00000X
TXPA01421363AM0700X
TXPA01580207Q00000X
TXPA04980363A00000X
TXH8229207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXE57360Medicare UPIN
TX89M682Medicare ID - Type UnspecifiedRICHARD C MALE JR DO
TX8B8345Medicare UPIN
TXE93584Medicare UPIN
TXR74827Medicare UPIN
TX5287700001Medicare NSC