# LAKE TRAVIS ER, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1215449954
- **Authorized official:** NICOLE CAMPBELL (DIRECTOR OF PATIENT ACCESS)
- **Authorized official phone:** (512) 948-1752

## Contact information

- **Practice address:** 5012 RANCH ROAD 620 NORTH, AUSTIN, TX 78732
- **Practice address phone:** (512) 260-2732
- **Mailing address:** 1464 E WHITESTONE BLVD STE 1101, CEDAR PARK, TX 78613-9070

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207P00000X | Emergency Medicine Physician | — | NULL | — |
| 207P00000X | Emergency Medicine Physician | — | — | — |
| 207R00000X | Internal Medicine Physician | — | NULL | — |
| 207R00000X | Internal Medicine Physician | — | — | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | — |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |
| 261QU0200X | Urgent Care Clinic/Center | — | NULL | — |
| 282N00000X | General Acute Care Hospital | — | NULL | Yes |

## Other

- **Enumeration date:** 11/03/2017
- **Last updated:** 02/11/2025