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General NPI Number Information
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NPI Number | 1669603361
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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 | 07/30/2009
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Last Update Date | 05/06/2025
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Provider Practice Location Address
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Address Line | 2423 WILLIAMS DR
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City | GEORGETOWN
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State | TX
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Zip | 78628-3200
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Country | US
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Telephone | 877-800-5722
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Fax |
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Provider Business Mailing Address
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Address Line | 2423 WILLIAMS DR STE 107
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City | GEORGETOWN
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State | TX
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Zip | 78628-3269
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Country | US
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Telephone | 877-800-5722
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Fax | 512-551-0163
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Authorized Official
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Title or Position | CEO
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Name | JONATHAN DAVID CALVIN
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Credential |
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Telephone | 512-994-1933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QF0400X
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Taxonomy Name | Federally Qualified Health Center (FQHC)
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License Number |
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License Number State |
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