Provider Demographics
NPI:1134242811
Name:CITY OF AUSTIN
Entity type:Organization
Organization Name:CITY OF AUSTIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:B
Authorized Official - Last Name:VLIET
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-972-5205
Mailing Address - Street 1:15 WALLER ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78702-5240
Mailing Address - Country:US
Mailing Address - Phone:512-972-4088
Mailing Address - Fax:512-972-4086
Practice Address - Street 1:15 WALLER ST
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78702-5240
Practice Address - Country:US
Practice Address - Phone:512-972-4088
Practice Address - Fax:512-972-4086
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CITY OF AUSTIN
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-09
Last Update Date:2008-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00HE66Medicare PIN