Basic Information
| Provider Information | |||||||||
| NPI: | 1679528889 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ST. DAVID'S HEALTHCARE PARTNERSHIP, L.P., LLP | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ST. DAVID'S SOUTH AUSTIN MEDICAL CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 901 W BEN WHITE BLVD | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787046903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124472211 | ||||||||
| FaxNumber: | 5124487326 | ||||||||
| Practice Location | |||||||||
| Address1: | 901 W BEN WHITE BLVD | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787046903 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5124472211 | ||||||||
| FaxNumber: | 5124487326 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 06/03/2021 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | HUFFINE | ||||||||
| AuthorizedOfficialFirstName: | DANIEL | ||||||||
| AuthorizedOfficialMiddleName: | W. | ||||||||
| AuthorizedOfficialTitleorPosition: | CFO | ||||||||
| AuthorizedOfficialTelephone: | 5128166111 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| 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 | 200466320A | 05 | IN | MEDICAID | 450713 | 01 | STERLING OPTION | OTHER | 1707741 | 05 | LA | MEDICAID | 3341335 | 01 | HEALTHMARKET | OTHER | 376100300 | 01 | US DEPT OF LABOR | OTHER | 450713 | 01 | UNICARE | OTHER | 1015259170001 | 05 | PA | MEDICAID | HH0762 | 01 | TX | BLUE CROSS/MEDVIEW | OTHER | 300193 | 01 | BLACK LUNG | OTHER | 5000164 | 01 | UNITED HEALTHCARE | OTHER | 913549900 | 05 | FL | MEDICAID | 04300581 | 05 | MS | MEDICAID | 0616440 | 01 | AETNA/US HEALTHCARE | OTHER | 112717702 | 05 | TX | MEDICAID |