Provider Demographics
NPI:1437378213
Name:HAYS CISD WELL CLINIC
Entity Type:Organization
Organization Name:HAYS CISD WELL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBERTS
Authorized Official - Suffix:
Authorized Official - Credentials:RN, MSN
Authorized Official - Phone:512-268-8474
Mailing Address - Street 1:21003 IH 35
Mailing Address - Street 2:
Mailing Address - City:KYLE
Mailing Address - State:TX
Mailing Address - Zip Code:78640-4745
Mailing Address - Country:US
Mailing Address - Phone:512-268-5218
Mailing Address - Fax:512-268-5219
Practice Address - Street 1:3839 E FM 150
Practice Address - Street 2:
Practice Address - City:KYLE
Practice Address - State:TX
Practice Address - Zip Code:78640-6072
Practice Address - Country:US
Practice Address - Phone:512-268-5218
Practice Address - Fax:512-268-5219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-24
Last Update Date:2011-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX251300000X
TX587900363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251300000XAgenciesLocal Education Agency (LEA)Group - Single Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182837801Medicaid
TX182837803Medicaid
TX182837802Medicaid
TX182837803Medicaid