Provider Demographics
NPI:1689740789
Name:DEPARTMENT OF STATE HEALTH SERVICES
Entity Type:Organization
Organization Name:DEPARTMENT OF STATE HEALTH SERVICES
Other - Org Name:TEXAS DSHS - HSR 2&3 ARLINGTON
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY REGIONAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EARLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:QUINN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:817-264-4500
Mailing Address - Street 1:1100 W 49TH ST
Mailing Address - Street 2:HSR 2&3 - ARLINGTON
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-3101
Mailing Address - Country:US
Mailing Address - Phone:512-458-7111
Mailing Address - Fax:
Practice Address - Street 1:1301 S BOWEN RD
Practice Address - Street 2:SUITE 200, ATTN BILLING OFFICE
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76013-2269
Practice Address - Country:US
Practice Address - Phone:817-264-4500
Practice Address - Fax:817-264-4506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX261QP0905X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP0905XAmbulatory Health Care FacilitiesClinic/CenterPublic Health, State or Local
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPH0025Medicare ID - Type Unspecified