1598793077 NPI number — CENTRAL TEXAS COMMUNITY HEALTH CENTERS

Table of content: (NPI 1598793077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598793077 NPI number — CENTRAL TEXAS COMMUNITY HEALTH CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL TEXAS COMMUNITY HEALTH CENTERS
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:
COMMUNITYCARE--MANOR
Provider Other Organization Name Type Code:
5
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:
1598793077
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17366
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:
78760-7366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-978-9000
Provider Business Mailing Address Fax Number:
512-978-9001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
600 W CARRIE MANOR ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MANOR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78653-5035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-978-9780
Provider Business Practice Location Address Fax Number:
512-978-9781
Provider Enumeration Date:
06/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MIDDLETON
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGED CARE CONTRACT MANAGER
Authorized Official Telephone Number:
512-978-9427

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2046831-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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