1003547407 NPI number — TENDERHEART HEALTH OUTCOMES, INC.

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 1003547407 NPI number — TENDERHEART HEALTH OUTCOMES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TENDERHEART HEALTH OUTCOMES, 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:
LONGHORN HEALTH SOLUTIONS
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:
1003547407
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 DIRECTORS BLVD STE 520
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:
78744-1105
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
877-394-1860
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
304 REGENCY CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DOTHAN
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36305-1175
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
877-394-1860
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2022

Additional Information

Authorized Official

Authorized Official Last Name:
WADLE
Authorized Official First Name:
LC
Authorized Official Middle Name:
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
512-217-5198

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 117896100 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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