Provider Demographics
NPI:1982020681
Name:COMMUNITY CLINICAL RESEARCH
Entity Type:Organization
Organization Name:COMMUNITY CLINICAL RESEARCH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIR,BUSINESS DEVELOPMENT
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROGGENKAMP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-665-8787
Mailing Address - Street 1:8334 CROSS PARK DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78754-5122
Mailing Address - Country:US
Mailing Address - Phone:512-323-2622
Mailing Address - Fax:512-323-2625
Practice Address - Street 1:8334 CROSS PARK DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78754-5122
Practice Address - Country:US
Practice Address - Phone:512-323-2622
Practice Address - Fax:512-323-2625
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-05
Last Update Date:2014-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1100XAmbulatory Health Care FacilitiesClinic/CenterResearch