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NPI Code Detail

MEDICARE: MR. CHARLES P HEGSTROM M.A.

MEDICARE: MR. CHARLES P HEGSTROM M.A.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1306363932
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. CHARLES P HEGSTROM M.A.
Provider Business Mailing Address
First Line : 1524 S IH 35 STE 210
Second Line :
City : AUSTIN
State : TX
Zip : 78704-2603
Country : US
Telephone Number : 512-343-8606
Fax Number :
Provider Business Practice Location Address
First Line : 1524 S IH 35 STE 210
Second Line :
City : AUSTIN
State : TX
Zip : 78704-2603
Country : US
Telephone Number : 512-343-8606
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2017
Last Update Date : 08/24/2017

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Directions to “ MR. CHARLES P HEGSTROM M.A.” Practice Location

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