1962719914 NPI number — CENTRAL TEXAS COMMUNITY HEALTH CENTERS

Table of content: (NPI 1962719914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962719914 NPI number — CENTRAL TEXAS COMMUNITY HEALTH CENTERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL TEXAS COMMUNITY HEALTH CENTERS
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:
1962719914
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 17366
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:
78760-7366
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-978-9000
Provider Business Mailing Address Fax Number:
512-978-9001

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1313 RED RIVER ST
Provider Second Line Business Practice Location Address:
STE. 320
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78701-1936
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-978-8870
Provider Business Practice Location Address Fax Number:
512-279-7367
Provider Enumeration Date:
09/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SLOAN
Authorized Official First Name:
JOY
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
512-978-9000

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2183592.01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com