1841455730 NPI number — CITY OF AUSTIN

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841455730 NPI number — CITY OF AUSTIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF AUSTIN
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:
HHSD IMMUNIZATION PROGRAM FAR SOUTH
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:
1841455730
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 WALLER ST
Provider Second Line Business Mailing Address:
#400
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78702-5240
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-972-5522
Provider Business Mailing Address Fax Number:
512-972-6225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 W STASSNEY LN
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:
78745-3146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-972-6260
Provider Business Practice Location Address Fax Number:
512-442-7983
Provider Enumeration Date:
07/21/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BECKER
Authorized Official First Name:
KURT
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
MANAGER, IMMUNIZATIONS
Authorized Official Telephone Number:
512-972-5523

Provider Taxonomy Codes

  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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