Provider Demographics
NPI:1922091453
Name:BUILDING A STRONGER COMMUNITY TOMORROW THROUGH THE CHILDREN OF TODAY I
Entity Type:Organization
Organization Name:BUILDING A STRONGER COMMUNITY TOMORROW THROUGH THE CHILDREN OF TODAY I
Other - Org Name:ROUND ROCK HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:D
Authorized Official - Last Name:ANGEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-255-5120
Mailing Address - Street 1:2120 N MAYS ST
Mailing Address - Street 2:430
Mailing Address - City:ROUND ROCK
Mailing Address - State:TX
Mailing Address - Zip Code:78664-2192
Mailing Address - Country:US
Mailing Address - Phone:512-255-5120
Mailing Address - Fax:512-255-5268
Practice Address - Street 1:2120 N MAYS ST
Practice Address - Street 2:430
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-2192
Practice Address - Country:US
Practice Address - Phone:512-255-5120
Practice Address - Fax:512-255-5268
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX673804Medicare ID - Type Unspecified