NPIMap

Organization Active NPI

Fredericksburg LTC

  • Long Term Care Pharmacy
  • Fredericksburg, TX
National Provider Identifier
1174767362
Registry record updated Mar 1, 2017
On this page

Key facts

NPPES NPI Registry
Primary specialty
Long Term Care PharmacyTaxonomy code 3336L0003X
License
26428 Issued in TX
Legal business name
FREDERICKSBURG LTC
Practice address
707 N Llano St
Suite B
Fredericksburg, TX 78624-3943
Phone
(830) 997-5800
Fax
(830) 997-0068
NPI assigned
May 1, 2009
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Mar 1, 2017

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Whitney RobertsNPI 1275129215
Title
Owner
Phone
(830) 997-5800

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Long Term Care Pharmacy 3336L0003X 26428 TX Primary

Addresses

Primary practice location

707 N Llano St
Suite B
Fredericksburg, TX 78624-3943

Mailing address

707 N Llano St
Suite B
Fredericksburg, TX 78624-3943
Phone (830) 997-5800

Other identifiers 2

IdentifierTypeStateIssuer
2120084OtherPK
350224MedicaidTX

Other names 1

  • Fredericksburg LTC Doing business as

National Provider Directory

National Provider Directory

Locations

707 N Llano St
Ste B
Fredericksburg, TX 78624
Phone (830) 997-5800

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1241136000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1488326400000",
    "number": "1174767362",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "707 N LLANO ST",
            "address_2": "SUITE B",
            "city": "FREDERICKSBURG",
            "state": "TX",
            "postal_code": "786243943",
            "telephone_number": "830-997-5800",
            "fax_number": "830-997-0068"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "707 N LLANO ST",
            "address_2": "SUITE B",
            "city": "FREDERICKSBURG",
            "state": "TX",
            "postal_code": "786243943",
            "telephone_number": "830-997-5800",
            "fax_number": "830-997-0068"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FREDERICKSBURG LTC",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-05-01",
        "last_updated": "2017-03-01",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "WHITNEY",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "830-997-5800"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "TX",
            "license": "26428",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2120084",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "350224",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Fredericksburg LTC",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Fredericksburg, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 1, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.