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General NPI Number Information
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NPI Number | 1609396928
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Entity Type | Organization
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Legal Business Name | LTC SUPPORT SERVICES PLLC
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Dates
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Enumeration Date | 06/27/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 7620 DEER RUN
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City | LEANDER
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State | TX
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Zip | 78641
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Country | US
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Telephone | 512-699-8819
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Fax |
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Provider Business Mailing Address
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Address Line | 7620 DEER RUN
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City | LEANDER
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State | TX
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Zip | 78641-6108
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Country | US
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Telephone | 512-699-8819
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAMES PAINTER CHUDLEIGH JR.
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Credential | MD
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Telephone | 512-699-8819
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QG0300X
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Taxonomy Name | Geriatric Medicine (Family Medicine) Physician
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License Number | F1450
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License Number State | TX
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