# BLACKHAWK PHYSICIAN GROUP

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- **Entity:** Organization
- **Status:** Active
- **Parent organization:** BLACKHAWK HEALTHCARE, LLC
- **Organization subpart:** Yes

## Provider details

- **NPI number:** 1609021765
- **Legal business name:** BLACKHAWK HEALTHCARE, LLC
- **Authorized official:** TODD BIEDERMAN (PRESIDENT/CEO)
- **Authorized official phone:** (512) 681-3440

## Contact information

- **Practice address:** 1700 BRAZOS AVE, ROCKDALE, TX 76567-2517
- **Practice address phone:** (512) 446-4502
- **Mailing address:** 6500 RIVER PLACE BLVD, BUILDING 1, SUITE 350, AUSTIN, TX 78730-1119
- **Mailing address phone:** (512) 681-3440

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208D00000X | General Practice Physician | — | NULL | Yes |
| 208D00000X | General Practice Physician | — | — | Yes |

## Other

- **Enumeration date:** 11/17/2008
- **Last updated:** 11/17/2008