1750337259 NPI number — AUSTIN TRAVIS COUNTY MENTAL HEALTH AND MENTAL RETARDATION CENTER

Table of content: (NPI 1750337259)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750337259 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:
Provider Other Organization Name Type Code:
6
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:
1750337259
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1430 COLLIER 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:
78704-2911
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-447-4141
Provider Business Mailing Address Fax Number:
512-440-4080

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1430 COLLIER 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:
78704-2911
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:
05/26/2006

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 103TC2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 106H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 171M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QD1600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 017413801 . This is a "ECI CM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1335424-01 . This is a "MR SC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1335242-02 . This is a "MH CM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00P336 . This is a "BLUE CROSS BLUE SHIELD TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1335424-04 . This is a "MH REHAB" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 133542405 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com