1982605374 NPI number — ERIC F ROEHM MD

Table of content: ERIC F ROEHM MD (NPI 1982605374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982605374 NPI number — ERIC F ROEHM MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROEHM
Provider First Name:
ERIC
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982605374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4189
Provider Second Line Business Mailing Address:
AUSTIN HEART
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78765-4189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-206-4300
Provider Business Mailing Address Fax Number:
512-206-4350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7200 WYOMING SPGS
Provider Second Line Business Practice Location Address:
STE 1400, AUSTIN HEART, ROUND ROCK #1
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78681-4303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-244-2263
Provider Business Practice Location Address Fax Number:
512-244-0846
Provider Enumeration Date:
08/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  F4441 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 048695 . This is a "GREAT WEST" identifier . This identifiers is of the category "OTHER".
  • Identifier: 78681-C002 . This is a "CHAMPUS / TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 50473 . This is a "FIRST HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 832880 . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 12827253 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 324409 . This is a "USA MANAGED CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4313543 . This is a "AETNA / TRS" identifier . This identifiers is of the category "OTHER".




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