Provider Demographics
NPI:1154472967
Name:UCP PHYSICIANS OF CENTRAL TEXAS, PLLC
Entity type:Organization
Organization Name:UCP PHYSICIANS OF CENTRAL TEXAS, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:
Authorized Official - First Name:CHRIS
Authorized Official - Middle Name:
Authorized Official - Last Name:KANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:480-498-4058
Mailing Address - Street 1:2145 E BASELINE RD STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85283-1546
Mailing Address - Country:US
Mailing Address - Phone:480-498-4058
Mailing Address - Fax:480-776-0025
Practice Address - Street 1:6001 W WILLIAM CANNON DR STE 302
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78749-1973
Practice Address - Country:US
Practice Address - Phone:512-288-3627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z226Medicare PIN