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General NPI Number Information
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NPI Number | 1558669895
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Entity Type | Organization
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Legal Business Name | CTMF, INC.
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Dates
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Enumeration Date | 03/10/2011
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Last Update Date | 03/10/2011
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Provider Practice Location Address
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Address Line | 4900 MUELLER BLVD DELL CHILDREN'S MEDICAL CENTER OF CENTRAL TEXAS
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City | AUSTIN
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State | TX
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Zip | 78723-3079
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Country | US
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Telephone | 201-805-7149
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Fax |
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Provider Business Mailing Address
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Address Line | 4900 MUELLER BLVD DELL CHILDREN'S MEDICAL CENTER OF CENTRAL TEXAS
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City | AUSTIN
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State | TX
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Zip | 78723-3079
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Country | US
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Telephone | 201-805-7149
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Fax |
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Authorized Official
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Title or Position | VICE PRESIDENT AND COO
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Name | BRUCE BROSLAT
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Credential |
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Telephone | 512-324-5845
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | 791036
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License Number State | TX
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