Basic Information
| Provider Information | |||||||||
| NPI: | 1922091453 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BUILDING A STRONGER COMMUNITY TOMORROW THROUGH THE CHILDREN OF TODAY I | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ROUND ROCK HEALTH CLINIC | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2120 N MAYS ST | ||||||||
| Address2: | 430 | ||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786642192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122555120 | ||||||||
| FaxNumber: | 5122555268 | ||||||||
| Practice Location | |||||||||
| Address1: | 2120 N MAYS ST | ||||||||
| Address2: | 430 | ||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 786642192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5122555120 | ||||||||
| FaxNumber: | 5122555268 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/30/2005 | ||||||||
| LastUpdateDate: | 08/22/2020 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | ANGEL | ||||||||
| AuthorizedOfficialFirstName: | CARL | ||||||||
| AuthorizedOfficialMiddleName: | D | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5122555120 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.