Provider Demographics
NPI:1538338306
Name:ROUND ROCK MENTAL HEALTH PA
Entity type:Organization
Organization Name:ROUND ROCK MENTAL HEALTH PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ANDREW
Authorized Official - Last Name:MUSGROVE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-964-6992
Mailing Address - Street 1:1717 N IH 35 STE 200
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-2901
Mailing Address - Country:US
Mailing Address - Phone:512-964-6992
Mailing Address - Fax:512-388-0373
Practice Address - Street 1:1717 N IH 35 STE 200
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2901
Practice Address - Country:US
Practice Address - Phone:512-964-6992
Practice Address - Fax:512-388-0373
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363AM0700X
TXM33342084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1940058-01Medicaid
TX1940058-01Medicaid