Healthcare Provider Details

I. General information

NPI: 1518237429
Provider Name (Legal Business Name): LONESTAR HOSPITAL MEDICINE ASSOCIATES, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 10/12/2020
Certification Date: 10/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 E BROAD ST
MANSFIELD TX
76063-5899
US

IV. Provider business mailing address

1643 NW 136TH AVE STE 100
SUNRISE FL
33323-2857
US

V. Phone/Fax

Practice location:
  • Phone: 682-622-2000
  • Fax:
Mailing address:
  • Phone: 800-424-3672
  • Fax: 954-377-3042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number
License Number State

VIII. Authorized Official

Name: LANCE D WILLIAMS
Title or Position: PRESIDENT
Credential: MD
Phone: 405-820-4403