| Dose Management Pa | |
|
3007 Longhorn Blvd Ste 102 Austin TX 78758-7632 | |
| (512) 566-4234 | |
| (833) 516-4233 |
| Full Name | Dose Management Pa |
|---|---|
| Speciality | Clinic/Center |
| Location | 3007 Longhorn Blvd Ste 102, Austin, Texas |
| Authorized Official Name and Position | Laurie Macdonald East (CFO) |
| Authorized Official Contact | 5126996801 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dose Management Pa 2111 Kramer Ln Ste 100 Austin TX 78758-4032 Ph: (512) 566-4233 | Dose Management Pa 3007 Longhorn Blvd Ste 102 Austin TX 78758-7632 Ph: (512) 566-4234 |
| NPI Number | 1447874334 |
|---|---|
| Provider Enumeration Date | 06/05/2020 |
| Last Update Date | 05/08/2024 |
| Medicare PECOS PAC ID | 0648692673 |
|---|---|
| Medicare Enrollment ID | O20200622001162 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447874334 | NPI | - | NPPES |
| 412890201 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
| Provider Name | Solomon Pendleton |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1134329600 PECOS PAC ID: 3678742152 Enrollment ID: I20110818000293 |
| Provider Name | Candice Gabrielle Brase |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1295240174 PECOS PAC ID: 4385904366 Enrollment ID: I20180213000677 |
| Provider Name | Roven Chino Olayres Escanillas |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1154980324 PECOS PAC ID: 8123354537 Enrollment ID: I20190723002774 |
| Provider Name | Dustyn Williams |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1699064766 PECOS PAC ID: 7810113404 Enrollment ID: I20200622001256 |
| Provider Name | Jeremy Polman |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1659831360 PECOS PAC ID: 9335476290 Enrollment ID: I20220716000114 |
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