Provider Demographics
NPI:1699729681
Name:ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP
Entity type:Organization
Organization Name:ST DAVIDS HEALTHCARE PARTNERSHIP LP LLP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:WIESS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-341-6404
Mailing Address - Street 1:2400 ROUND ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78681-4004
Mailing Address - Country:US
Mailing Address - Phone:512-255-6066
Mailing Address - Fax:512-238-1799
Practice Address - Street 1:2400 ROUND ROCK AVE
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78681-4004
Practice Address - Country:US
Practice Address - Phone:512-255-6066
Practice Address - Fax:512-238-1799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2018-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX22529401Medicaid