Provider Demographics
NPI:1578690798
Name:AUSTIN TRAVIS COUNTY MHMR CENTER
Entity Type:Organization
Organization Name:AUSTIN TRAVIS COUNTY MHMR CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:RUSSEL
Authorized Official - Last Name:VAN NORMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:512-440-4021
Mailing Address - Street 1:PO BOX 3548
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78764-3548
Mailing Address - Country:US
Mailing Address - Phone:512-445-7787
Mailing Address - Fax:512-440-4059
Practice Address - Street 1:1631 E 2ND ST STE D
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-4491
Practice Address - Country:US
Practice Address - Phone:512-804-3600
Practice Address - Fax:512-476-1469
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered251B00000XAgenciesCase Management
Not Answered251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00P336OtherBLUE CROSS BLUE SHIELD
TX00P336Medicare ID - Type Unspecified