1336456227 NPI number — TRI-COUNTY CLINICAL

Table of content: (NPI 1336456227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336456227 NPI number — TRI-COUNTY CLINICAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI-COUNTY CLINICAL
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:
SETON FAMILY OF DOCTORS
Provider Other Organization Name Type Code:
4
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:
1336456227
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/23/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1345 PHILOMENA ST
Provider Second Line Business Mailing Address:
SUITE 410.3
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-324-8960
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
130 HAYS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LULING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-324-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/13/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CARNSER
Authorized Official First Name:
CLAYTON
Authorized Official Middle Name:
Authorized Official Title or Position:
VP/COO
Authorized Official Telephone Number:
512-324-5846

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 280565701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 280565706 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 280565702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".