Provider Demographics
NPI:1336456227
Name:TRI-COUNTY CLINICAL
Entity Type:Organization
Organization Name:TRI-COUNTY CLINICAL
Other - Org Name:SETON FAMILY OF DOCTORS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:VP/COO
Authorized Official - Prefix:
Authorized Official - First Name:CLAYTON
Authorized Official - Middle Name:
Authorized Official - Last Name:CARNSER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-324-5846
Mailing Address - Street 1:1345 PHILOMENA ST
Mailing Address - Street 2:SUITE 410.3
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78723
Mailing Address - Country:US
Mailing Address - Phone:512-324-8960
Mailing Address - Fax:
Practice Address - Street 1:130 HAYS ST
Practice Address - Street 2:
Practice Address - City:LULING
Practice Address - State:TX
Practice Address - Zip Code:78648
Practice Address - Country:US
Practice Address - Phone:512-324-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-09-13
Last Update Date:2023-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX280565701Medicaid
TX280565706Medicaid
TX280565702Medicaid
TX280565706Medicaid