1649223645 NPI number — ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP

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 1649223645 NPI number — ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST DAVIDS HEALTHCARE PARTNERSHIP LP 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:
ROUND ROCK MEDICAL CENTER
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:
1649223645
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2400 ROUND ROCK AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROUND ROCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78681-4004
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-255-6066
Provider Business Mailing Address Fax Number:
512-238-1799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2400 ROUND ROCK AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78681-4004
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-255-6066
Provider Business Practice Location Address Fax Number:
512-238-1799
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WIESS
Authorized Official First Name:
LAURA
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
512-341-6404

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 10025291400 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH0771 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 598714 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300195 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: 3342268 . This is a "HEALTHMARKET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0462803 . This is a "AETNA/US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 450718 . This is a "STERLING OPTION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5000158 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 782781812 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020957901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100105600B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1744051 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 450718 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04533764 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 177678300 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 450718 . This is a "WORKMANS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 020957902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2781831 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 450718 , issued by the state of ( TN ) . This identifiers is of the category "MEDICAID".




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