Basic Information
| Provider Information | |||||||||
| NPI: | 1063752970 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SETON FAMILY OF DOCTORS | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| OtherOrganizationName: | TRI COUNTY PRACTICE ASSOCIATION | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5301-B DAVIS LN | ||||||||
| Address2: | STE 200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123455925 | ||||||||
| FaxNumber: | 5123383066 | ||||||||
| Practice Location | |||||||||
| Address1: | 5301-B DAVIS LN | ||||||||
| Address2: | STE 200 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78749 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123455925 | ||||||||
| FaxNumber: | 5123383066 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2013 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | CARSNER | ||||||||
| AuthorizedOfficialFirstName: | CLAYTON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP/COO | ||||||||
| AuthorizedOfficialTelephone: | 5123245846 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | Y | Suppliers | Durable Medical Equipment & Medical Supplies |
No ID Information.