Black Acre Emergency Physicians Medical Group PLLC

Key facts

NPI

1013559707

Entity type

Organization (NPI type 2)

Primary specialty

Emergency Medicine Physician 207P00000X

Legal business name

BLACK ACRE EMERGENCY PHYSICIANS MEDICAL GROUP PLLC

Practice address

100 Medical Pkwy
Lakeway, TX 78738-5621

Phone

(817) 451-4208

Fax

(817) 563-3699

NPI assigned

Oct 14, 2019

Organization subpart

No

Authorized official

Name

Brian C Dawson, MD

Title

Owner

Phone

(817) 451-4208

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Steven Peter Maron, M.D. Emergency Medicine Physician · Merced, CA · NPI 1821026063
  NPD (past) EMERGENCY MEDICINE

National Provider Directory

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Oct 14, 2019.

{
    "created_epoch": "1571011200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1571011200000",
    "number": "1013559707",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 8292",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761240292",
            "telephone_number": "817-451-4208",
            "fax_number": "817-563-3699"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "100 MEDICAL PKWY",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787385621",
            "telephone_number": "817-451-4208",
            "fax_number": "817-563-3699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLACK ACRE EMERGENCY PHYSICIANS MEDICAL GROUP PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-10-14",
        "last_updated": "2019-10-14",
        "status": "A",
        "authorized_official_last_name": "DAWSON",
        "authorized_official_first_name": "BRIAN",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "817-451-4208",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Emergency Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Lakeway, TX · Emergency Medicine Physician in Texas