Provider Demographics
NPI:1649407834
Name:TEXAS DEPARTMENT OF STATE HEALTH SERVICES
Entity Type:Organization
Organization Name:TEXAS DEPARTMENT OF STATE HEALTH SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REVENUE MANAGEMENT UNIT MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:KELLY-KING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-458-7111
Mailing Address - Street 1:1100 WEST 49TH STREET
Mailing Address - Street 2:P.O. BOX 149347
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78714-9347
Mailing Address - Country:US
Mailing Address - Phone:512-458-7111
Mailing Address - Fax:512-458-7588
Practice Address - Street 1:1100 WEST 49TH STREET
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78714-9347
Practice Address - Country:US
Practice Address - Phone:512-458-7111
Practice Address - Fax:512-458-7588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-06-16
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site