Provider Demographics
NPI:1497532204
Name:GENERALHEALTHGROUP OF TEXAS
Entity Type:Organization
Organization Name:GENERALHEALTHGROUP OF TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MNG DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:RUTH
Authorized Official - Middle Name:
Authorized Official - Last Name:BERENSTEIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-686-0096
Mailing Address - Street 1:244 5TH AVE # L270
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-7604
Mailing Address - Country:US
Mailing Address - Phone:646-907-6299
Mailing Address - Fax:
Practice Address - Street 1:5511 PARKCREST DR STE 103
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78731-4917
Practice Address - Country:US
Practice Address - Phone:646-907-6299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERALHEALTH GROUP INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty