Provider Demographics
NPI:1417979014
Name:SETON FAMILY OF HOSPITALS
Entity Type:Organization
Organization Name:SETON FAMILY OF HOSPITALS
Other - Org Name:SETON HIGHLAND LAKES MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:INTERIM PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARZA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-324-1981
Mailing Address - Street 1:PO BOX 1219
Mailing Address - Street 2:
Mailing Address - City:BURNET
Mailing Address - State:TX
Mailing Address - Zip Code:78611-7219
Mailing Address - Country:US
Mailing Address - Phone:512-715-3000
Mailing Address - Fax:512-756-6405
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:512-715-3360
Practice Address - Fax:512-756-6505
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SETON HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-24
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000559367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00405RMedicare ID - Type Unspecified