Provider Demographics
NPI:1265460745
Name:CENTRAL TEXAS COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:CENTRAL TEXAS COMMUNITY HEALTH CENTERS
Other - Org Name:COMMUNITYCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGED CARE CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:512-978-9427
Mailing Address - Street 1:4614 N IH 35
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-3401
Mailing Address - Country:US
Mailing Address - Phone:512-978-9139
Mailing Address - Fax:512-978-9141
Practice Address - Street 1:4614 N IH 35
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78751-3401
Practice Address - Country:US
Practice Address - Phone:512-978-9100
Practice Address - Fax:512-901-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QF0400X, 333600000X, 3336C0002X
TX264613336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No333600000XSuppliersPharmacy
No3336C0002XSuppliersPharmacyClinic Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2046666-01Medicaid
2097549OtherPK
TX2046666-01Medicaid
451944Medicare Oscar/Certification
TX0A5444Medicare UPIN