1679528889 NPI number — ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP

Table of content: (NPI 1679528889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679528889 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 SOUTH AUSTIN 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:
1679528889
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:
901 W BEN WHITE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78704-6903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-447-2211
Provider Business Mailing Address Fax Number:
512-448-7326

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 W BEN WHITE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-6903
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-447-2211
Provider Business Practice Location Address Fax Number:
512-448-7326
Provider Enumeration Date:
05/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LEE
Authorized Official First Name:
BRYAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
512-816-6111

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: 04300581 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200466320A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 450713 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1015259170001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0616440 . This is a "AETNA/US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 112717702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 300193 . This is a "BLACK LUNG" identifier . This identifiers is of the category "OTHER".
  • Identifier: HH0762 . This is a "BLUE CROSS/MEDVIEW" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3341335 . This is a "HEALTHMARKET" identifier . This identifiers is of the category "OTHER".
  • Identifier: 376100300 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1707741 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5000164 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 450713 . This is a "STERLING OPTION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 913549900 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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