Provider Demographics
NPI:1790455343
Name:CENTRAL ATHLETE
Entity Type:Organization
Organization Name:CENTRAL ATHLETE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER AND HEAD COACH
Authorized Official - Prefix:
Authorized Official - First Name:JESSE
Authorized Official - Middle Name:ALEXANDER
Authorized Official - Last Name:OBRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-680-7783
Mailing Address - Street 1:1023 SPRINGDALE RD BLDG 9B
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78721-2442
Mailing Address - Country:US
Mailing Address - Phone:512-672-6760
Mailing Address - Fax:
Practice Address - Street 1:1023 SPRINGDALE RD BLDG 9B
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78721-2442
Practice Address - Country:US
Practice Address - Phone:512-672-6760
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-15
Last Update Date:2021-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service