Organization
LONE STAR CIRCLE OF CARE
Active
Parent organization
LONE STAR CIRCLE OF CARE
Other names
A.W. Grimes Medical Offices
Organization subpart
Yes
Provider details
NPI number
Legal business name
LONE STAR CIRCLE OF CARE
Authorized official
MR. PETER C PERIALAS JR. (CHIEF EXECUTIVE OFFICER)
(512) 868-1124
Entity
Organization
Contact information
Practice address
2051 GATTIS SCHOOL RD, SUITE 250, ROUND ROCK, TX 78664-7441
(877) 800-5722
(512) 238-5492
Mailing address
205 E UNIVERSITY AVE, SUITE 200, GEORGETOWN, TX 78626-6814
(512) 868-1124
(512) 868-9894
Taxonomy
Speciality
Code
Description
License number
State
261QF0400X
Federally Qualified Health Center (FQHC)
Primary
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
206351301
—
TX
Enumeration date
10/22/2008
Last updated
03/03/2011
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