Provider Demographics
NPI:1366996647
Name:MY BLUEBONNET COMPANY, LLC
Entity type:Organization
Organization Name:MY BLUEBONNET COMPANY, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:BUSINESS DEVELOPMENT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:QING
Authorized Official - Middle Name:
Authorized Official - Last Name:LIU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-867-6200
Mailing Address - Street 1:13359 N HIGHWAY 183
Mailing Address - Street 2:STE403
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78750-7153
Mailing Address - Country:US
Mailing Address - Phone:512-867-6200
Mailing Address - Fax:512-519-1127
Practice Address - Street 1:13359 N HIGHWAY 183
Practice Address - Street 2:STE403
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78750-7153
Practice Address - Country:US
Practice Address - Phone:512-867-6200
Practice Address - Fax:512-519-1127
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-04
Last Update Date:2016-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty