| Emerald Medical Ny Pc | |
|
823 Congress Ave Ste 1200 Austin TX 78701-2402 | |
| (855) 422-3855 | |
| Not Available |
| Full Name | Emerald Medical Ny Pc |
|---|---|
| Speciality | General Practice |
| Location | 823 Congress Ave Ste 1200, Austin, Texas |
| Authorized Official Name and Position | Brantley Jolly (PRESIDENT/OWNER) |
| Authorized Official Contact | 8554223855 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Emerald Medical Ny Pc 823 Congress Ave Ste 1200 Austin TX 78701-2402 Ph: () - | Emerald Medical Ny Pc 823 Congress Ave Ste 1200 Austin TX 78701-2402 Ph: (855) 422-3855 |
| NPI Number | 1508605973 |
|---|---|
| Provider Enumeration Date | 05/23/2024 |
| Last Update Date | 05/23/2024 |
| Medicare PECOS PAC ID | 0941749782 |
|---|---|
| Medicare Enrollment ID | O20240826000992 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1508605973 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 208D00000X | General Practice | (* (Not Available)) | Primary |
| Provider Name | Bonita G Tao |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1912191164 PECOS PAC ID: 9830271022 Enrollment ID: I20080126000166 |
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