1013991017 NPI number — EASTER SEALS CENTRAL TEXAS, INC.

Table of content: (NPI 1013991017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013991017 NPI number — EASTER SEALS CENTRAL TEXAS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EASTER SEALS CENTRAL TEXAS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013991017
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/24/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2324 RIDGEPOINT DR STE F1
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78754-5214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-615-6800
Provider Business Mailing Address Fax Number:
512-615-7121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2324 RIDGEPOINT DR STE F1
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78754-5214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-615-6800
Provider Business Practice Location Address Fax Number:
512-615-7121
Provider Enumeration Date:
12/02/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KHOURY
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
212-727-4270

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  18436 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 133V00000X , with the licence number: DT02978 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2251P0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 225XP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 231H00000X , with the licence number: 51670 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: 51670 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 252Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0401X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0082CM . This is a "BLUE CROSS PROVIDER GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 126129901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 004760702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 021286202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 021286201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 021286204 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 172268801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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