1093995714 NPI number — LONE STAR UROLOGY PLLC

Table of content: (NPI 1093995714)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093995714 NPI number — LONE STAR UROLOGY PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LONE STAR UROLOGY PLLC
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:
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:
1093995714
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2911 MEDICAL ARTS ST STE 1A
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:
78705-3376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-476-9850
Provider Business Mailing Address Fax Number:
512-236-8867

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2911 MEDICAL ARTS ST STE 1A
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:
78705-3376
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-476-9850
Provider Business Practice Location Address Fax Number:
512-236-8867
Provider Enumeration Date:
11/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
ALEMAN
Authorized Official First Name:
MICAELA
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
512-476-9850

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  K0598 , 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)

  • Identifier: 157730601 . This is a "MEDICAID GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8845B6 . This is a "MEDICARE INDIV" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8Z1915 . This is a "BCBS INDIV" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1578672739 . This is a "NPI INDIVIDUAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3469HM . This is a "BCBS GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1093995714 . This is a "NPI GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 113480104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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