Healthcare Provider Details

I. General information

NPI: 1770764300
Provider Name (Legal Business Name): LONE STAR CIRCLE OF CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/26/2007
Last Update Date: 10/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

205 E UNIVERSITY AVE SUITE 200
GEORGETOWN TX
78626-6814
US

IV. Provider business mailing address

205 E UNIVERSITY AVE SUITE 200
GEORGETOWN TX
78626-6814
US

V. Phone/Fax

Practice location:
  • Phone: 512-868-1124
  • Fax: 512-868-9894
Mailing address:
  • Phone: 512-868-1124
  • Fax: 512-868-9894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: MS. RHONDA MUNDHENK
Title or Position: CEO
Credential:
Phone: 512-868-1124