1649223645 NPI number — ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP

Table of content: (NPI 1649223645)

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:
Provider Other Organization Name Type Code:
6
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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