1477596716 NPI number — ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P, LLP

Table of content: (NPI 1477596716)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477596716 NPI number — ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P, LLP
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:
ST. DAVID'S GEORGETOWN HOSPITAL
Provider Other Organization Name Type Code:
3
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:
1477596716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2000 SCENIC DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GEORGETOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78626-7726
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-943-3000
Provider Business Mailing Address Fax Number:
512-943-4477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 SCENIC DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GEORGETOWN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78626-7726
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-943-3000
Provider Business Practice Location Address Fax Number:
512-943-4477
Provider Enumeration Date:
06/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MCKNIGHT
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
512-544-5030

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 6541215 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020836501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000016022N . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: HH053 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: B2097 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1648418 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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