| Lscc Obgyn | |
|
2300 Round Rock Ave Ste 208 Round Rock TX 78681-4026 | |
| (877) 800-5722 | |
| (512) 255-5307 |
| Full Name | Lscc Obgyn |
|---|---|
| Speciality | Clinic/Center |
| Location | 2300 Round Rock Ave Ste 208, Round Rock, Texas |
| Authorized Official Name and Position | Jonathan David Calvin (CEO) |
| Authorized Official Contact | 5129941933 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Lscc Obgyn 205 E University Ave Suite 200 Georgetown TX 78626-6814 Ph: (877) 800-5722 | Lscc Obgyn 2300 Round Rock Ave Ste 208 Round Rock TX 78681-4026 Ph: (877) 800-5722 |
| NPI Number | 1447316898 |
|---|---|
| Provider Enumeration Date | 12/29/2006 |
| Last Update Date | 09/18/2023 |
| Medicare PECOS PAC ID | 5193709392 |
|---|---|
| Medicare Enrollment ID | O20070125000561 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1447316898 | NPI | - | NPPES |
| 1560575-08 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | 261QF0400X (Texas) | Primary |
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