1184730988 NPI number — HEALTH AND HUMAN SERVICES COMMISSION

Table of content: (NPI 1184730988)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184730988 NPI number — HEALTH AND HUMAN SERVICES COMMISSION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH AND HUMAN SERVICES COMMISSION
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:
NORTH TEXAS STATE HOSPITAL (VERNON CAMPUS)
Provider Other Organization Name Type Code:
3
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:
1184730988
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4110 GUADALUPE ST
Provider Second Line Business Mailing Address:
HOSPITAL REVENUE MGMT. - MC2028
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78751-4223
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-206-5011
Provider Business Mailing Address Fax Number:
512-206-5302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4730 COLLEGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76384-4009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-552-4055
Provider Business Practice Location Address Fax Number:
940-553-2523
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM SUPERVISOR VI
Authorized Official Telephone Number:
512-438-3124

Provider Taxonomy Codes

  • Taxonomy code: 3336I0012X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1081036-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1301640-07 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH3011 . This is a "BCBS ADOLESCENT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1081036-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH4008 . This is a "BCBS FORENSIC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0211963-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4539219 . This is a "PHARMACY NCPDP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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