Provider Demographics
NPI:1639129331
Name:LONE STAR CIRCLE OF CARE
Entity type:Organization
Organization Name:LONE STAR CIRCLE OF CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:CALVIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-994-1933
Mailing Address - Street 1:2423 WILLIAMS DR STE 107
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78628-3269
Mailing Address - Country:US
Mailing Address - Phone:877-800-5722
Mailing Address - Fax:
Practice Address - Street 1:2411 WILLIAMS DR
Practice Address - Street 2:SUITE 111
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78628-3271
Practice Address - Country:US
Practice Address - Phone:877-800-5722
Practice Address - Fax:512-864-1447
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2025-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1560575-03Medicaid