1245344472 NPI number — HEALTH AND HUMAN SERVICES COMMISSION

Table of content: (NPI 1245344472)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245344472 NPI number — HEALTH AND HUMAN SERVICES COMMISSION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH AND HUMAN SERVICES COMMISSION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
NORTH TEXAS STATE HOSPITAL (VERNON CAMPUS)
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1245344472
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
701 W 51ST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78751-2312
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-438-5618
Provider Business Mailing Address Fax Number:
512-438-4220

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4730 COLLEGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
VERNON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76384-4009
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-552-4055
Provider Business Practice Location Address Fax Number:
940-553-2523
Provider Enumeration Date:
08/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARNETT
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM SUPERVISOR
Authorized Official Telephone Number:
512-438-5618

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1301640-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH4008 . This is a "BCBS FORENSIC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4539219 . This is a "PHARMACY NCPDP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1081036-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0211963-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1081036-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH3011 . This is a "BCBS ADOLESCENT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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