Provider Demographics
NPI:1912107178
Name:LONE STAR UROGYNECOLOGY AND CONTINENCE CENTER, PLLC
Entity Type:Organization
Organization Name:LONE STAR UROGYNECOLOGY AND CONTINENCE CENTER, PLLC
Other - Org Name:CENTRAL TEXAS UROGYNECOLOGY AND CONTINENCE CENTER, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TOMAS
Authorized Official - Middle Name:G
Authorized Official - Last Name:ANTONINI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-716-0861
Mailing Address - Street 1:3407 GLENVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-1448
Mailing Address - Country:US
Mailing Address - Phone:512-716-0861
Mailing Address - Fax:866-765-3913
Practice Address - Street 1:3407 GLENVIEW AVE
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-1448
Practice Address - Country:US
Practice Address - Phone:512-716-0861
Practice Address - Fax:866-765-3913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-24
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL4221207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00Y617Medicare PIN