Provider Demographics
NPI:1518333004
Name:CENTRAL TEXAS COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:CENTRAL TEXAS COMMUNITY HEALTH CENTERS
Other - Org Name:COMMUNITYCARE AT SANDRA JOY ANDERSON COMMUNITY HEALTH AND WELLNESS CEN
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KONECNY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-978-9000
Mailing Address - Street 1:PO BOX 17366
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78760-7366
Mailing Address - Country:US
Mailing Address - Phone:512-978-9000
Mailing Address - Fax:
Practice Address - Street 1:1705 E 11TH ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-2709
Practice Address - Country:US
Practice Address - Phone:512-978-8400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL TEXAS COMMUNITY HEALTH CENTERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-08-19
Last Update Date:2015-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)