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General NPI Number Information
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NPI Number | 1497941348
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Entity Type | Organization
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Legal Business Name | INTREPID OF AUSTIN-PEDIATRICS
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Dates
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Enumeration Date | 09/24/2007
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Last Update Date | 09/24/2007
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Provider Practice Location Address
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Address Line | 1812 CENTRE CREEK DR STE 100
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City | AUSTIN
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State | TX
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Zip | 78754-5132
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Country | US
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Telephone | 512-833-6454
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1450
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City | MINNEAPOLIS
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State | MN
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Zip | 55485-1450
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF REVENUE CYCLE
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Name | TERESA JACKSON
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Credential |
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Telephone | 21444537750
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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