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NPI Code Detail

MEDICARE: LONE STAR CIRCLE OF CARE

MEDICARE: LONE STAR CIRCLE OF CARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1261QF0400XFederally Qualified Health Center (FQHC)

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
274-1883OTHERMEDICARE PTAN

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1306236187
Entity Type Code : Organization
Provider Name (Legal Business Name) : LONE STAR CIRCLE OF CARE
Provider Business Mailing Address
First Line : 2423 WILLIAMS DR STE 107
Second Line :
City : GEORGETOWN
State : TX
Zip : 78628-3269
Country : US
Telephone Number : 877-800-5722
Fax Number :
Provider Business Practice Location Address
First Line : 605 OLD AUSTIN HWY
Second Line :
City : BASTROP
State : TX
Zip : 78602-5034
Country : US
Telephone Number : 877-800-5722
Fax Number :
Authorized Official
Title or Position : CEO
Name : JONATHAN DAVID CALVIN
Credential :
Telephone Number : 512-994-1933
Provider Enumeration Date : 01/30/2015
Last Update Date : 05/12/2025

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Directions to “LONE STAR CIRCLE OF CARE ” Practice Location

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