Provider Demographics
NPI:1730181793
Name:FAMILY MEDICINE ASSOCIATES OF ROUND ROCK, P.A.
Entity type:Organization
Organization Name:FAMILY MEDICINE ASSOCIATES OF ROUND ROCK, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:R
Authorized Official - Last Name:LEWIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-244-1995
Mailing Address - Street 1:7200 WYOMING SPGS
Mailing Address - Street 2:STE 600
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4305
Mailing Address - Country:US
Mailing Address - Phone:512-244-1995
Mailing Address - Fax:512-244-2090
Practice Address - Street 1:7200 WYOMING SPGS
Practice Address - Street 2:STE 600
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4305
Practice Address - Country:US
Practice Address - Phone:512-244-1995
Practice Address - Fax:512-244-2090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-02
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN/A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00L37SOtherFMA BLUE HMO
TX00L37SOtherFMA BLUE PPO
TX5859685OtherFMA CIGNA HMO
TX5512136OtherFMA AETNA HMO
TX083725401Medicaid
TX5512136OtherFMA AETNA PPO
TX5859685OtherFMA CIGNA PPO
TXCG5740OtherFMA RRB MEDICARE UNIT
TX00L37SMedicare ID - Type UnspecifiedFMA MEDICARE