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General NPI Number Information
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NPI Number | 1639245764
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF STATE HEALTH SERVICES
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Dates
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Enumeration Date | 11/28/2006
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Last Update Date | 03/19/2009
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Provider Practice Location Address
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Address Line | 2408 S 37TH ST ATTN BILLING OFFICE
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City | TEMPLE
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State | TX
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Zip | 76504-7168
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Country | US
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Telephone | 254-778-6744
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Fax | 254-778-6819
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Provider Business Mailing Address
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Address Line | 1100 W 49TH ST HSR 7 - TEMPLE
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City | AUSTIN
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State | TX
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Zip | 78756-3101
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Country | US
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Telephone | 512-458-7111
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Fax |
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Authorized Official
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Title or Position | DEPUTY REGIONAL DIRECTOR
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Name | THOMAS BETZ
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Credential |
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Telephone | 254-778-6744
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP0905X
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Taxonomy Name | State or Local Public Health Clinic/Center
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License Number |
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License Number State | TX
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