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General NPI Number Information
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NPI Number | 1194161968
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Entity Type | Organization
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Legal Business Name | TEXAS HEALTH & SCIENCE UNIVERSITY PROFESSIONAL CLINIC
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 05/20/2013
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Provider Practice Location Address
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Address Line | 1707 FORTVIEW RD
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City | AUSTIN
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State | TX
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Zip | 78704-7620
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Country | US
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Telephone | 512-445-2222
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Fax |
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Provider Business Mailing Address
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Address Line | 1707 FORTVIEW RD
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City | AUSTIN
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State | TX
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Zip | 78704-7620
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Country | US
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Telephone | 512-445-2222
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Fax |
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Authorized Official
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Title or Position | PRESIDENT, CEO
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Name | MS. LISA LIN
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Credential |
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Telephone | 512-914-8888
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | AC01408
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License Number State | TX
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