Basic Information
| Provider Information | |||||||||
| NPI: | 1013570027 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL TEXAS COMMUNITY HEALTH CENTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2115 KRAMER LN | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787584013 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789914 | ||||||||
| FaxNumber: | 5129019706 | ||||||||
| Practice Location | |||||||||
| Address1: | 4614 N IH 35 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787513401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/16/2019 | ||||||||
| LastUpdateDate: | 04/16/2019 | ||||||||
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| AuthorizedOfficialLastName: | HAYS | ||||||||
| AuthorizedOfficialFirstName: | ASHLEE | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER CONTRACTING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5129789914 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | N | Suppliers | Pharmacy | 3336C0002X | N | Suppliers | Pharmacy | Clinic Pharmacy | 3336C0003X | Y | Suppliers | Pharmacy | Community/Retail Pharmacy |
No ID Information.