Provider Demographics
NPI:1366484529
Name:PARK BEND HEALTH CENTER
Entity Type:Organization
Organization Name:PARK BEND HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT OF OPERATION
Authorized Official - Prefix:MR
Authorized Official - First Name:DOUGLAS
Authorized Official - Middle Name:M
Authorized Official - Last Name:HOWERTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-703-2200
Mailing Address - Street 1:2122 PARK BEND DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78758-5352
Mailing Address - Country:US
Mailing Address - Phone:512-836-9777
Mailing Address - Fax:512-833-9759
Practice Address - Street 1:2122 PARK BEND DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-5352
Practice Address - Country:US
Practice Address - Phone:512-836-9777
Practice Address - Fax:512-833-9759
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX100244314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX675862Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER