| Organization Name: | ROCKDALE BLACKHAWK LLC |
| NPI Number: | 1033483086 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | JEFFREY P MADISON (CEO) |
| Mailing Address: | 5656 Bee Cave Rd Suite M-300 West Lake Hills |
| State: | TX US |
| Postal Code: | 787465280 |
| Phone Number: | 5128073270 |
| Fax Number: | 5128073328 |
| NPI Enumeration Date: | 03/07/2012 |
| NPI Last Update Date: | 05/14/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |