BASTROP COUNTY MEDICAL & ASSOCIATES PA NPI 1063539542

NPI Information

NPI: 1063539542
Provider Name: BASTROP COUNTY MEDICAL & ASSOCIATES, PA
Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 45D2180254

Address:
489 AGNES ST
STE 100
BASTROP, TX
ZIP 78602
Phone: (512) 321-9091
Get Directions

BASTROP COUNTY MEDICAL & ASSOCIATES, PA is a specialist in Bastrop, TX. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. BASTROP COUNTY MEDICAL & ASSOCIATES, PA NPI is 1063539542. The provider is registered as an organization entity type and is a single specialty group.

The provider's business location address is:

489 AGNES ST
STE 100
BASTROP, TX
ZIP 78602-156
Phone: (512) 321-9091
Fax: (512) 549-3005

The provider's authorized official is Rajeev Gupta .
The authorized official title is Owner and has the following contact phone number (512) 321-9091.

The CLIA number assigned to this NPI record is 45D2180254 - federally qualified health center with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 3/22/2007 and was last updated on 11/30/2016.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	174400000X	Specialist		K0795	TEXAS	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	00853N	MEDICARE PIN	TEXAS
2	G98250	MEDICARE UPIN	TEXAS
3	092494601	MEDICAID	TEXAS
4	0071DM	OTHER	TEXAS	BCBS
5	10008423	OTHER	TEXAS	AMERIGROUP
6	DG3304	OTHER	TEXAS	RAILROAD MEDICARE

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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