NPIMap

Organization Active NPI

Lake Travis Pharmacy Partners LLC

Doing business as Lake Hills Pharmacy

  • Pharmacy
  • Austin, TX
National Provider Identifier
1285065870
Registry record updated Dec 6, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacyTaxonomy code 333600000X
License
28908 Issued in TX
Legal business name
LAKE TRAVIS PHARMACY PARTNERS LLC
Doing business as
Lake Hills Pharmacy
Practice address
12005 Bee Cave Pkwy Ste 1a
Austin, TX 78738-6387
Phone
(512) 608-9355
NPI assigned
Dec 6, 2013
Last updated
Dec 6, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 6, 2013

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

Authorized official

Name
Bruce McAnallyNPI 1013069707
Title
Owner
Phone
(214) 734-8878

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X 28908 TX Primary
Community/Retail Pharmacy 3336C0003X
Compounding Pharmacy 3336C0004X
Long Term Care Pharmacy 3336L0003X

Addresses

Primary practice location

12005 Bee Cave Pkwy Ste 1a
Austin, TX 78738-6387

Mailing address

12005 Bee Cave Rd
Suite 1a
Austin, TX 78738
Phone (512) 608-9355

Other names 1

  • Lake Hills Pharmacy Doing business as

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20160218001574 TX Part B Supplier - Mass Immunization (Roster Biller Only) 5597060160 Practice locations: Bee Cave, TX

National Provider Directory

National Provider Directory
Tax ID family
Lake Hills Pharmacy4 organizations share this tax ID, including this one

Other organizations with this tax ID 3

Organizations that report the same tax identification number in the National Provider Directory.

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1386288000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1386288000000",
    "number": "1285065870",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12005 BEE CAVE RD",
            "address_2": "SUITE 1A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "78738",
            "telephone_number": "512-608-9355"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12005 BEE CAVE PKWY STE 1A",
            "city": "AUSTIN",
            "state": "TX",
            "postal_code": "787386387",
            "telephone_number": "512-608-9355"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LAKE TRAVIS PHARMACY PARTNERS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-06",
        "last_updated": "2013-12-06",
        "status": "A",
        "authorized_official_last_name": "MCANALLY",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "214-734-8878"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": "TX",
            "license": "28908",
            "primary": true
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0004X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Compounding Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Lake Hills Pharmacy",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Austin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 6, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.