Basic Information
| Provider Information | |||||||||
| NPI: | 1487686226 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CENTRAL TEXAS PALLIATIVE CARE ASSOCIATES | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | AUSTIN PALLIATIVE CARE | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 4107 SPICEWOOD SPRINGS RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787598645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123973360 | ||||||||
| FaxNumber: | 5123437107 | ||||||||
| Practice Location | |||||||||
| Address1: | 4107 SPICEWOOD SPRINGS RD STE 100 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787598645 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123973360 | ||||||||
| FaxNumber: | 5123437107 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 11/10/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | TYRPAK | ||||||||
| AuthorizedOfficialFirstName: | DESIREE | ||||||||
| AuthorizedOfficialMiddleName: | EVANS | ||||||||
| AuthorizedOfficialTitleorPosition: | PRACTICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5123424753 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 11/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LH0002X | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Hospice and Palliative Medicine | 207QH0002X | N | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | Hospice and Palliative Medicine | 2080H0002X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Hospice and Palliative Medicine | 251G00000X | N | Agencies | Hospice Care, Community Based | 207RH0002X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Hospice and Palliative Medicine |
ID Information
| ID | Type | State | Issuer | Description | 0078HJ | 01 | TX | BLUE CROSS BLUE SHIELD | OTHER | 165704101 | 05 | TX | MEDICAID |