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NPI Code Detail

MEDICARE: MISSISSIPPI LITHOTRIPTERS, LP

MEDICARE: MISSISSIPPI LITHOTRIPTERS, LP
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
1208800000XUrology Physician
2261QL0400XLithotripsy Clinic/Center

General Provider Information

NPI Number : 1518048677
Entity Type Code : Organization
Provider Name (Legal Business Name) : MISSISSIPPI LITHOTRIPTERS, LP
Provider Business Mailing Address
First Line : 1990 STEAM WAY STE A102
Second Line :
City : ROUND ROCK
State : TX
Zip : 78665-2233
Country : US
Telephone Number : 877-465-4845
Fax Number : 512-872-5101
Provider Business Practice Location Address
First Line : 1990 STEAM WAY STE A102
Second Line :
City : ROUND ROCK
State : TX
Zip : 78665-2233
Country : US
Telephone Number : 877-465-4845
Fax Number : 512-872-5101
Authorized Official
Title or Position : PAYER RELATIONS
Name : LATANYA CASTILE
Credential :
Telephone Number : 847-544-5939
Provider Enumeration Date : 10/17/2006
Last Update Date : 07/01/2024

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