Healthcare Provider Details

I. General information

NPI: 1780612275
Provider Name (Legal Business Name): CENTRAL TEXAS COMMUNITY HEALTH CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 08/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 S 1ST ST
AUSTIN TX
78704-5466
US

IV. Provider business mailing address

PO BOX 17366
AUSTIN TX
78760-7366
US

V. Phone/Fax

Practice location:
  • Phone: 512-978-9500
  • Fax: 512-978-9558
Mailing address:
  • Phone: 512-978-9000
  • Fax: 512-978-9001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: CAROLYN KONECNY
Title or Position: CFO
Credential:
Phone: 512-978-9000