| Organization Name: | BASTROP MEDICAL CLINIC P A |
| NPI Number: | 1043236201 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | AUGUSTIN ROGER BATLLE (MEDICAL DOCTOR) |
| Mailing Address: | 195 S Hasler Blvd Suite B-1 Bastrop |
| State: | TX US |
| Postal Code: | 786024081 |
| Phone Number: | 5123081555 |
| Fax Number: | 5123081565 |
| NPI Enumeration Date: | 07/14/2006 |
| NPI Last Update Date: | 08/10/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QP2300X |
| License Number: | J6324 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Primary Care |
| Taxonomy Definition: | |