Healthcare Provider Details

I. General information

NPI: 1861893927
Provider Name (Legal Business Name): CHEN HALL PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2014
Last Update Date: 09/09/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15808 RANCH ROAD 620 N SUITE 100
AUSTIN TX
78717-4922
US

IV. Provider business mailing address

15808 RANCH ROAD 620 N SUITE 100
AUSTIN TX
78717-4922
US

V. Phone/Fax

Practice location:
  • Phone: 512-244-3554
  • Fax: 512-244-2942
Mailing address:
  • Phone: 512-244-3554
  • Fax: 512-244-2942

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: GWEN KINNIBRUGH
Title or Position: ADMINISTRATOR
Credential:
Phone: 512-244-3554