Provider Demographics
NPI:1568296952
Name:LONE STAR EXTENSIVISTS PLLC
Entity type:Organization
Organization Name:LONE STAR EXTENSIVISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:FARRAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-710-4265
Mailing Address - Street 1:PO BOX 310605
Mailing Address - Street 2:
Mailing Address - City:NEW BRAUNFELS
Mailing Address - State:TX
Mailing Address - Zip Code:78131-0605
Mailing Address - Country:US
Mailing Address - Phone:830-620-0330
Mailing Address - Fax:830-620-5405
Practice Address - Street 1:29924 FM 3009
Practice Address - Street 2:
Practice Address - City:NEW BRAUNFELS
Practice Address - State:TX
Practice Address - Zip Code:78132-2637
Practice Address - Country:US
Practice Address - Phone:830-620-0330
Practice Address - Fax:830-620-5405
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-28
Last Update Date:2024-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty