Provider Demographics
NPI:1568643104
Name:LILLY MANAGEMENT
Entity type:Organization
Organization Name:LILLY MANAGEMENT
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:GENERAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:HOLDEN
Authorized Official - Last Name:RUSHING
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:512-295-9345
Mailing Address - Street 1:1762 FM 967 STE A
Mailing Address - Street 2:
Mailing Address - City:BUDA
Mailing Address - State:TX
Mailing Address - Zip Code:78610-2983
Mailing Address - Country:US
Mailing Address - Phone:512-295-9345
Mailing Address - Fax:
Practice Address - Street 1:1762 FM 967 STE A
Practice Address - Street 2:
Practice Address - City:BUDA
Practice Address - State:TX
Practice Address - Zip Code:78610-2983
Practice Address - Country:US
Practice Address - Phone:512-295-9345
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-26
Last Update Date:2008-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9479305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Z164Medicare PIN