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General NPI Number Information
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NPI Number | 1588096473
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Entity Type | Organization
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Legal Business Name | LONE STAR CIRCLE OF CARE
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Dates
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Enumeration Date | 08/02/2013
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Last Update Date | 08/02/2013
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Provider Practice Location Address
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Address Line | 101 FM 685
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City | HUTTO
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State | TX
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Zip | 78634-5540
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Country | US
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Telephone | 512-686-0207
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Fax |
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Provider Business Mailing Address
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Address Line | 205 E UNIVERSITY AVE SUITE 200
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City | GEORGETOWN
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State | TX
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Zip | 78626-6814
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Country | US
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Telephone | 512-686-0207
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | PETE PERIALAS
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Credential |
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Telephone | 512-686-0207
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 53594
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 660624
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | P4217
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License Number State | TX
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