1003833013 NPI number — ASCENSION SETON

Table of content: (NPI 1003833013)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003833013 NPI number — ASCENSION SETON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ASCENSION SETON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
ASCENSION SETON HIGHLAND LAKES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1003833013
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1345 PHILOMENA DRIVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78723-3185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-324-1000
Provider Business Mailing Address Fax Number:
512-459-5629

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3201 S WATER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BURNET
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78611-4510
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-715-3000
Provider Business Practice Location Address Fax Number:
512-756-6405
Provider Enumeration Date:
07/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CORDOLA
Authorized Official First Name:
CRAIG
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
512-324-1000

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  000559 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282NC0060X , with the licence number: 000559 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 094151004 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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