Healthcare Provider Details

I. General information

NPI: 1336373513
Provider Name (Legal Business Name): LMO HEALTHCARELLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/04/2009
Last Update Date: 05/04/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4161 E HIGHWAY 290 STE 400
DRIPPING SPRINGS TX
78620-4446
US

IV. Provider business mailing address

4161 E HIGHWAY 290 STE 400
DRIPPING SPRINGS TX
78620-4446
US

V. Phone/Fax

Practice location:
  • Phone: 512-858-9580
  • Fax: 512-858-9582
Mailing address:
  • Phone: 512-858-9580
  • Fax: 512-858-9582

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State

VIII. Authorized Official

Name: JORGE ORTIZ
Title or Position: PRESIDENT/MEMBER
Credential: MD
Phone: 512-858-9590