1629021845 NPI number — ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP

Table of content: (NPI 1629021845)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629021845 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:
NORTH 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:
1629021845
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:
12221 N MO PAC EXPY
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:
78758-2401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-901-1000
Provider Business Mailing Address Fax Number:
512-901-1995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12221 N MO PAC EXPY
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:
78758-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-901-1000
Provider Business Practice Location Address Fax Number:
512-901-1995
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BAKER
Authorized Official First Name:
JON
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
512-901-2503

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: 0494580 . This is a "AETNA/US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1287369 . This is a "UNITED HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 450809 . This is a "WORKMANS COMP" identifier . This identifiers is of the category "OTHER".
  • Identifier: XHSP42897 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 165564800 . This is a "US DEPT OF LABOR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 450809 . This is a "UNICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 621516424 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 07636250 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 450809 . This is a "STERLING OPTION" identifier . This identifiers is of the category "OTHER".
  • Identifier: HH0908 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 094216103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1729124 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3341065 . This is a "HEALTHMARKET" identifier . This identifiers is of the category "OTHER".




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