PUREFYT COMMUNITY CARE

Provider Demographics

• NPI: 1104542448
• Name: PUREFYT COMMUNITY CARE
• Entity type: Organization
• Organization Name: PUREFYT COMMUNITY CARE
• Authorized Official - Title/Position: CLINIC DIRECTOR
• Authorized Official - First Name: GE'O-VANNA
• Authorized Official - Last Name: SMITH
• Authorized Official - Phone: 512-998-5100
• Mailing Address - Street 1: 708 LOREY LN
• Mailing Address - City: CALDWELL
• Mailing Address - State: TX
• Mailing Address - Zip Code: 77836-1384
• Mailing Address - Country: US
• Mailing Address - Phone: 512-775-3704
• Mailing Address - Fax: 737-800-1011
• Practice Address - Street 1: 14205 N MOPAC EXY
• Practice Address - Street 2: STE. 570 PMB #565290
• Practice Address - City: AUSTIN
• Practice Address - State: TX
• Practice Address - Zip Code: 78728
• Practice Address - Country: US
• Practice Address - Phone: 512-775-3704
• Practice Address - Fax: 737-800-1011
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2022-10-18
• Last Update Date: 2024-11-18

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	261QM1300X	Ambulatory Health Care Facilities	Clinic/Center	Multi-Specialty	Group - Multi-Specialty
No	101YM0800X	Behavioral Health & Social Service Providers	Counselor	Mental Health	Group - Multi-Specialty
No	103TH0004X	Behavioral Health & Social Service Providers	Psychologist	Health	Group - Multi-Specialty
No	208D00000X	Allopathic & Osteopathic Physicians	General Practice		Group - Multi-Specialty
No	208VP0000X	Allopathic & Osteopathic Physicians	Pain Medicine	Pain Medicine	Group - Multi-Specialty
No	225100000X	Respiratory, Developmental, Rehabilitative and Restorative Service Providers	Physical Therapist		Group - Multi-Specialty
No	261QF0050X	Ambulatory Health Care Facilities	Clinic/Center	Family Planning, Non-Surgical
No	261QI0500X	Ambulatory Health Care Facilities	Clinic/Center	Infusion Therapy
No	261QM0801X	Ambulatory Health Care Facilities	Clinic/Center	Mental Health (Including Community Mental Health Center)
No	261QM0850X	Ambulatory Health Care Facilities	Clinic/Center	Adult Mental Health
No	261QM0855X	Ambulatory Health Care Facilities	Clinic/Center	Adolescent and Children Mental Health
No	261QP2000X	Ambulatory Health Care Facilities	Clinic/Center	Physical Therapy
No	261QP2400X	Ambulatory Health Care Facilities	Clinic/Center	Prison Health
No	261QR1300X	Ambulatory Health Care Facilities	Clinic/Center	Rural Health
No	364SP0812X	Physician Assistants & Advanced Practice Nursing Providers	Clinical Nurse Specialist	Psychiatric/Mental Health, Community	Group - Multi-Specialty