MEDICARE: CENTRAL TEXAS COMMUNITY HEALTH CENTERS

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
1	261QF0400X	Federally Qualified Health Center (FQHC)

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780612275
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CENTRAL TEXAS COMMUNITY HEALTH CENTERS

Provider Business Mailing Address
First Line	:	PO BOX 17366
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78760-7366
Country	:	US
Telephone Number	:	512-978-9000
Fax Number	:	512-978-9001

Provider Business Practice Location Address
First Line	:	2529 S 1ST ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78704-5466
Country	:	US
Telephone Number	:	512-978-9500
Fax Number	:	512-978-9558

Authorized Official
Title or Position	:	CFO
Name	:	CAROLYN KONECNY
Credential	:
Telephone Number	:	512-978-9000

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	08/14/2015

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