Provider Demographics
NPI:1184730988
Name:HEALTH AND HUMAN SERVICES COMMISSION
Entity type:Organization
Organization Name:HEALTH AND HUMAN SERVICES COMMISSION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM SUPERVISOR VI
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-438-3124
Mailing Address - Street 1:4110 GUADALUPE ST
Mailing Address - Street 2:HOSPITAL REVENUE MGMT. - MC2028
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78751-4223
Mailing Address - Country:US
Mailing Address - Phone:512-206-5011
Mailing Address - Fax:512-206-5302
Practice Address - Street 1:4730 COLLEGE DR
Practice Address - Street 2:
Practice Address - City:VERNON
Practice Address - State:TX
Practice Address - Zip Code:76384-4009
Practice Address - Country:US
Practice Address - Phone:940-552-4055
Practice Address - Fax:940-553-2523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX3336I0012X, 3336L0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336I0012XSuppliersPharmacyInstitutional Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1081036-02Medicaid
TX1301640-07Medicaid
TXHH3011OtherBCBS ADOLESCENT
TX1081036-01Medicaid
TXHH4008OtherBCBS FORENSIC
TX0211963-01Medicaid
TX4539219OtherPHARMACY NCPDP NUMBER
TXTXB131120Medicare PIN