1053632505 NPI number — AUSTIN TRAVIS COUNTY MENTAL HEALTH AND MENTAL RETARDATION CENTER

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 1053632505 NPI number — AUSTIN TRAVIS COUNTY MENTAL HEALTH AND MENTAL RETARDATION CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUSTIN TRAVIS COUNTY MENTAL HEALTH AND MENTAL RETARDATION CENTER
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:
INTEGRAL CARE
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:
1053632505
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3548
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:
78764-3548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-441-4747
Provider Business Mailing Address Fax Number:
512-440-4081

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1165 AIRPORT BLVD
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:
78702-3152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-472-4357
Provider Business Practice Location Address Fax Number:
512-703-1394
Provider Enumeration Date:
06/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
NUWAYHID
Authorized Official First Name:
ZIYAD
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
CHIEF MEDICAL OFFICER
Authorized Official Telephone Number:
512-447-4141

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  166-A , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 324500000X , with the licence number: 3022 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 212084201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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