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16040 Park Valley Dr Ste 222a Round Rock TX 78681-3596 | |
| (512) 553-1921 | |
| (512) 532-6502 |
| Full Name | |
|---|---|
| Speciality | Internal Medicine |
| Location | 16040 Park Valley Dr Ste 222a, Round Rock, Texas |
| Authorized Official Name and Position | Jared Lee (CHIEF ADMINISTRATIVE OFFICER) |
| Authorized Official Contact | 4029379392 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
16040 Park Valley Dr Ste 222a Round Rock TX 78681-3596 Ph: (512) 553-1921 | 16040 Park Valley Dr Ste 222a Round Rock TX 78681-3596 Ph: (512) 553-1921 |
| NPI Number | 1780128140 |
|---|---|
| Provider Enumeration Date | 12/05/2016 |
| Last Update Date | 10/04/2024 |
| Medicare PECOS PAC ID | 7214218452 |
|---|---|
| Medicare Enrollment ID | O20171208001757 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1780128140 | NPI | - | NPPES |
| Provider Name | John C Puente |
|---|---|
| Provider Type | Practitioner - Neurology |
| Provider Identifiers | NPI Number: 1194775916 PECOS PAC ID: 9638155583 Enrollment ID: I20040629001504 |
| Provider Name | Mark D Carlson |
|---|---|
| Provider Type | Practitioner - Hematology/oncology |
| Provider Identifiers | NPI Number: 1023008398 PECOS PAC ID: 2668461666 Enrollment ID: I20050720000590 |
| Provider Name | Jennifer R Asmus |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033542451 PECOS PAC ID: 3971727439 Enrollment ID: I20140624001744 |
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