Provider Demographics
NPI:1598793077
Name:CENTRAL TEXAS COMMUNITY HEALTH CENTERS
Entity Type:Organization
Organization Name:CENTRAL TEXAS COMMUNITY HEALTH CENTERS
Other - Org Name:COMMUNITYCARE--MANOR
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGED CARE CONTRACT MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:MIDDLETON
Authorized Official - Suffix:
Authorized Official - Credentials:CPCS
Authorized Official - Phone:512-978-9427
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:512-978-9001
Practice Address - Street 1:600 W CARRIE MANOR ST
Practice Address - Street 2:
Practice Address - City:MANOR
Practice Address - State:TX
Practice Address - Zip Code:78653-5035
Practice Address - Country:US
Practice Address - Phone:512-978-9780
Practice Address - Fax:512-978-9781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2021-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2046831-01Medicaid
TX0A5444Medicare PIN
TX2046831-01Medicaid