Basic Information
| Provider Information | |||||||||
| NPI: | 1629021845 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP | ||||||||
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| OtherOrganizationName: | NORTH AUSTIN MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12221 N MO PAC EXPY | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787582401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129011000 | ||||||||
| FaxNumber: | 5129011995 | ||||||||
| Practice Location | |||||||||
| Address1: | 12221 N MO PAC EXPY | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787582401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129011000 | ||||||||
| FaxNumber: | 5129011995 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2006 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
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| AuthorizedOfficialLastName: | LEONE | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5129012503 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 06/03/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 0494580 | 01 | AETNA/US HEALTHCARE | OTHER | XHSP42897 | 05 | CA | MEDICAID | 165564800 | 01 | US DEPT OF LABOR | OTHER | 621516424 | 01 | HUMANA | OTHER | 07636250 | 05 | MS | MEDICAID | 450809 | 01 | STERLING OPTION | OTHER | 450809 | 01 | WORKMANS COMP | OTHER | HH0908 | 01 | TX | BLUE CROSS | OTHER | 1287369 | 01 | UNITED HEALTHCARE | OTHER | 1729124 | 05 | LA | MEDICAID | 094216103 | 05 | TX | MEDICAID | 3341065 | 01 | HEALTHMARKET | OTHER | 450809 | 01 | UNICARE | OTHER |