Provider Demographics
| NPI: | 1639182967 |
|---|---|
| Name: | HEALTH AND HUMAN SERVICES COMMISSION |
| Entity Type: | Organization |
| Organization Name: | HEALTH AND HUMAN SERVICES COMMISSION |
| Other - Org Name: | RUSK STATE HOSPITAL |
| Other - Org Type: | Doing Business As |
| Authorized Official - Title/Position: | ACCOUNTANT III |
| Authorized Official - Prefix: | MRS |
| Authorized Official - First Name: | JANA |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | JOHNSON |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | |
| Authorized Official - Phone: | 512-206-5284 |
| Mailing Address - Street 1: | 4110 GUADALUPE ST |
| Mailing Address - Street 2: | HOSPITAL REVENUE MGMT-MC2023 |
| Mailing Address - City: | AUSTIN |
| Mailing Address - State: | TX |
| Mailing Address - Zip Code: | 78751-4223 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 512-206-5284 |
| Mailing Address - Fax: | 512-206-5302 |
| Practice Address - Street 1: | 805 NORTH DICKINSON |
| Practice Address - Street 2: | |
| Practice Address - City: | RUSK |
| Practice Address - State: | TX |
| Practice Address - Zip Code: | 75785-0318 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 903-683-7201 |
| Practice Address - Fax: | 903-683-7199 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2006-08-15 |
| Last Update Date: | 2017-08-25 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| TX | 103T00000X, 103TC0700X, 183500000X, 2084F0202X, 2084N0400X, 2084P0800X, 2084P0804X, 2084P0805X, 208D00000X, 363A00000X, 363L00000X, 364S00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 103T00000X | Behavioral Health & Social Service Providers | Psychologist | Group - Multi-Specialty | |
| No | 103TC0700X | Behavioral Health & Social Service Providers | Psychologist | Clinical | Group - Multi-Specialty |
| No | 183500000X | Pharmacy Service Providers | Pharmacist | Group - Multi-Specialty | |
| No | 2084F0202X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Forensic Psychiatry | Group - Multi-Specialty |
| No | 2084N0400X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Neurology | Group - Multi-Specialty |
| No | 2084P0800X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | Group - Multi-Specialty |
| No | 2084P0804X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | Group - Multi-Specialty |
| No | 2084P0805X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Geriatric Psychiatry | Group - Multi-Specialty |
| No | 208D00000X | Allopathic & Osteopathic Physicians | General Practice | Group - Multi-Specialty | |
| No | 363A00000X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Group - Multi-Specialty | |
| No | 363L00000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Group - Multi-Specialty | |
| No | 364S00000X | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| TX | HH4588 | Other | BCBS PSYCHIATRIC |
| TX | 0827925-01 | Medicaid | |
| TX | HH3006 | Other | BCBS DRUG/ALCOHOL |
| TX | 0638231-01 | Medicaid | |
| TX | 1333312-01 | Medicaid | |
| TX | 1333312-02 | Medicaid | |
| TX | 1333312-03 | Medicaid | |
| TX | 4537835 | Other | PHARMACY NCPDP |
| TX | 1333312-03 | Medicaid | |
| TX | 00G982 | Medicare PIN |
