Provider Demographics
NPI:1811051956
Name:SETON HEALTHCARE NETWORK
Entity type:Organization
Organization Name:SETON HEALTHCARE NETWORK
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPERATIONS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:PAT
Authorized Official - Middle Name:
Authorized Official - Last Name:GARRETT
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:512-324-7365
Mailing Address - Street 1:1400 NORTH IH35
Mailing Address - Street 2:ONE CHILDRENS PLACE ATTN PHARMACY
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1926
Mailing Address - Country:US
Mailing Address - Phone:512-324-7365
Mailing Address - Fax:512-324-8225
Practice Address - Street 1:1400 NORTH IH35
Practice Address - Street 2:ONE CHILDRENS PLACE ATTN PHARMACY
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-1926
Practice Address - Country:US
Practice Address - Phone:512-324-7365
Practice Address - Fax:512-324-8225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-21
Last Update Date:2007-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22534333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4528088OtherNCPDP
TX250473Medicaid