MEDICARE: EL BUEN SAMARITANO EPISCOPAL MISSION

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QC1500X	Community Health Clinic/Center		TX

General Provider Information

NPI Number	:	1003099433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EL BUEN SAMARITANO EPISCOPAL MISSION

Provider Business Mailing Address
First Line	:	7000 WOODHUE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745
Country	:	US
Telephone Number	:	512-439-0745
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 WOODHUE DR
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78745-5454
Country	:	US
Telephone Number	:	512-439-0701
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. TIMOTHY SAYLES
Credential	:	MBA
Telephone Number	:	512-439-0745

Provider Enumeration Date	:	12/07/2007
Last Update Date	:	10/22/2015

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