1609882083 NPI number — HEALTH AND HUMAN SERVICES COMMISSION

Table of content: (NPI 1609882083)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609882083 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:
AUSTIN STATE HOSPITAL
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:
1609882083
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2022
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:
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:
4110 GUADALUPE ST
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:
78751-4223
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-419-2666
Provider Business Practice Location Address Fax Number:
512-419-2683
Provider Enumeration Date:
07/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARNETT
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM SUPERVISOR VI
Authorized Official Telephone Number:
512-913-1580

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: 1218281-04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0211948-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0937807-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1218281-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4539637 . This is a "PHARMACY NCPDP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH3010 . This is a "BCBS DRUG/ALCOHOL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0827875-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1218281-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH4750 . This is a "BCBS PSYCHIATRIC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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