Provider Demographics
NPI:1417175506
Name:DAUGHTERS OF CHARITY HEALTH SERVICES OF AUSTIN
Entity Type:Organization
Organization Name:DAUGHTERS OF CHARITY HEALTH SERVICES OF AUSTIN
Other - Org Name:DELL CHILDRENS MEDICAL CENTER OF CENTRAL TEXAS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP, COO
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROSLAT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-324-7051
Mailing Address - Street 1:PO BOX 2298
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78298-2298
Mailing Address - Country:US
Mailing Address - Phone:800-962-3303
Mailing Address - Fax:
Practice Address - Street 1:1201 W 38TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1006
Practice Address - Country:US
Practice Address - Phone:512-324-7463
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207PE0004XAllopathic & Osteopathic PhysiciansEmergency MedicineEmergency Medical ServicesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPENDINGMedicare ID - Type Unspecified