Organization
M.D. ERA, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MICHAEL A MATTINGLY CRT, RCP (PRESIDENT)
(512) 554-8669
Entity
Organization
Contact information
Practice address
6521 BURNET LN, SUITE 108, AUSTIN, TX 78757-2848
(512) 454-2727
(512) 454-2728
Mailing address
6521 BURNET LN, SUITE 108, AUSTIN, TX 78757-2848
(512) 454-2727
(512) 454-2728
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
0091015
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
532275
BCBSTX PPO
TX
Enumeration date
07/13/2006
Last updated
04/20/2008
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