Healthcare Provider Details

I. General information

NPI: 1689740789
Provider Name (Legal Business Name): DEPARTMENT OF STATE HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 S BOWEN RD SUITE 200, ATTN BILLING OFFICE
ARLINGTON TX
76013-2269
US

IV. Provider business mailing address

1100 W 49TH ST HSR 2&3 - ARLINGTON
AUSTIN TX
78756-3101
US

V. Phone/Fax

Practice location:
  • Phone: 817-264-4500
  • Fax: 817-264-4506
Mailing address:
  • Phone: 512-458-7111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP0905X
TaxonomyState or Local Public Health Clinic/Center
License Number
License Number StateTX

VIII. Authorized Official

Name: EARLENE QUINN
Title or Position: DEPUTY REGIONAL DIRECTOR
Credential:
Phone: 817-264-4500