Provider Demographics
NPI:1164445094
Name:ASCENSION SETON
Entity Type:Organization
Organization Name:ASCENSION SETON
Other - Org Name:CHILDREN'S CARE-A-VAN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-324-1000
Mailing Address - Street 1:1345 PHILOMENA ST
Mailing Address - Street 2:SUITE 362
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723-3185
Mailing Address - Country:US
Mailing Address - Phone:512-324-1000
Mailing Address - Fax:512-380-7551
Practice Address - Street 1:3201 S WATER ST
Practice Address - Street 2:
Practice Address - City:BURNET
Practice Address - State:TX
Practice Address - Zip Code:78611-4510
Practice Address - Country:US
Practice Address - Phone:830-596-3081
Practice Address - Fax:512-406-6505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASCENSION SETON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-25
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX164174801Medicaid
458844Medicare ID - Type Unspecified