Basic Information
| Provider Information | |||||||||
| NPI: | 1508582503 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL TEXAS COMMUNITY HEALTH CENTERS | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 17366 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787607366 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789009 | ||||||||
| FaxNumber: | 5129019713 | ||||||||
| Practice Location | |||||||||
| Address1: | 6633 E HIGHWAY 290 STE 100 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787231157 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5129789015 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2022 | ||||||||
| LastUpdateDate: | 10/12/2022 | ||||||||
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| AuthorizedOfficialLastName: | MIDDLETON | ||||||||
| AuthorizedOfficialFirstName: | KIMBERLY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MANAGED CARE CONTRACT MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 5129789427 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPCS, AAS, BS | ||||||||
| NPICertificationDate: | 10/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.