MEDICARE: LONE STAR CIRCLE OF CARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QF0400X	Federally Qualified Health Center (FQHC)

General Provider Information

NPI Number	:	1134982333
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LONE STAR CIRCLE OF CARE

Provider Business Mailing Address
First Line	:	205 E UNIVERSITY AVE STE 200
Second Line	:
City	:	GEORGETOWN
State	:	TX
Zip	:	78626-6821
Country	:	US
Telephone Number	:	877-800-5722
Fax Number	:

Provider Business Practice Location Address
First Line	:	401 CHEETAH TRAIL
Second Line	:
City	:	HARKER HEIGHTS
State	:	TX
Zip	:	76548-5699
Country	:	US
Telephone Number	:	877-800-5722
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	JONATHAN DAVID CALVIN
Credential	:
Telephone Number	:	126-860-5235

Provider Enumeration Date	:	02/01/2024
Last Update Date	:	02/01/2024

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Directions to “LONE STAR CIRCLE OF CARE ” Practice Location

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