Provider Demographics
NPI:1154624260
Name:AGMP
Entity type:Organization
Organization Name:AGMP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:KIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:512-630-2467
Mailing Address - Street 1:5111B MARTIN AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-2118
Mailing Address - Country:US
Mailing Address - Phone:512-630-2467
Mailing Address - Fax:888-335-3210
Practice Address - Street 1:5111B MARTIN AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-2118
Practice Address - Country:US
Practice Address - Phone:512-630-2467
Practice Address - Fax:888-335-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN5158207R00000X, 2084P0800X
LAMD.024557207R00000X, 2084P0800X
MDD0063651207R00000X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty