Basic Information
| Provider Information | |||||||||
| NPI: | 1861447062 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | PARK BEND HEAL CENTER | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2122 PARK BEND DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787585352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128369777 | ||||||||
| FaxNumber: | 5128339759 | ||||||||
| Practice Location | |||||||||
| Address1: | 2122 PARK BEND DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787585352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128369777 | ||||||||
| FaxNumber: | 5128339759 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/24/2006 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| AuthorizedOfficialLastName: | HOWERTON | ||||||||
| AuthorizedOfficialFirstName: | DOUGLAS | ||||||||
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| AuthorizedOfficialTitleorPosition: | VICE PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 5128369777 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332BP3500X | Y | Suppliers | Durable Medical Equipment & Medical Supplies | Parenteral & Enteral Nutrition |
No ID Information.