1003051673 NPI number — LONE STAR CIRCLE OF CARE

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003051673 NPI number — LONE STAR CIRCLE OF CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONE STAR CIRCLE OF CARE
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003051673
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 WEST UNIVERSITY AVENUE
Provider Second Line Business Mailing Address:
SUITE 103
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78628-7109
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-868-1124
Provider Business Mailing Address Fax Number:
512-868-9894

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
905 IH 35 N
Provider Second Line Business Practice Location Address:
SUITE 109
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78664-4254
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-733-2100
Provider Business Practice Location Address Fax Number:
512-733-2101
Provider Enumeration Date:
12/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PERIALAS
Authorized Official First Name:
PETER
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
512-868-1124

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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