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General NPI Number Information
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NPI Number | 1215449954
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Entity Type | Organization
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Legal Business Name | LAKE TRAVIS ER, LLC
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Dates
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Enumeration Date | 11/03/2017
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 5012 RANCH ROAD 620 NORTH
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City | AUSTIN
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State | TX
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Zip | 78732
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Country | US
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Telephone | 512-260-2732
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Fax |
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Provider Business Mailing Address
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Address Line | 1464 E WHITESTONE BLVD STE 1101
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City | CEDAR PARK
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State | TX
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Zip | 78613-9070
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF PATIENT ACCESS
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Name | NICOLE CAMPBELL
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Credential |
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Telephone | 512-948-1752
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207P00000X
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Taxonomy Name | Emergency Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 282N00000X
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Taxonomy Name | General Acute Care Hospital
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License Number |
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License Number State |
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