1720377591 NPI number — AUSTIN TRAVIS COUNTY MHMR CENTER

Table of content: (NPI 1720377591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720377591 NPI number — AUSTIN TRAVIS COUNTY MHMR CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AUSTIN TRAVIS COUNTY MHMR 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:
AUSTIN TRAVIS COUNTY 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:
1720377591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2011
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:
512-472-4357
Provider Business Mailing Address Fax Number:
512-703-1394

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 EAST RUNDBERG LANE, UNIT F
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:
78753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-804-3900
Provider Business Practice Location Address Fax Number:
512-804-3901
Provider Enumeration Date:
04/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HARRISON
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
CHIEF FINANCIAL OFFIER, COO
Authorized Official Telephone Number:
512-440-4001

Provider Taxonomy Codes

  • Taxonomy code: 261QR0405X , with the licence number:  166 - 3396 , 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)





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