Provider Demographics
NPI:1710169198
Name:LONE STAR CIRCLE OF CARE
Entity Type:Organization
Organization Name:LONE STAR CIRCLE OF CARE
Other - Org Name:GCC TX HEALTH STEPS
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:PERIALAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:512-868-1124
Mailing Address - Street 1:1500 W UNIVERSITY AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-7109
Mailing Address - Country:US
Mailing Address - Phone:512-868-1124
Mailing Address - Fax:512-868-9894
Practice Address - Street 1:1500 W UNIVERSITY AVE STE 103
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-7109
Practice Address - Country:US
Practice Address - Phone:512-868-1124
Practice Address - Fax:512-868-9894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-28
Last Update Date:2007-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty