# TEXAS DEPARTMENT OF STATE HEALTH SERVICES

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1649407834
- **Authorized official:** MS. BARBARA SUZANNE KELLY-KING (REVENUE MANAGEMENT UNIT MANAGER)
- **Authorized official phone:** (512) 458-7111

## Contact information

- **Practice address:** 1100 WEST 49TH STREET, AUSTIN, TX 78714-9347
- **Practice address phone:** (512) 458-7111
- **Practice address fax:** (512) 458-7588
- **Mailing address:** 1100 WEST 49TH STREET, P.O. BOX 149347, AUSTIN, TX 78714-9347
- **Mailing address phone:** (512) 458-7111
- **Mailing address fax:** (512) 458-7588

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 332900000X | Non-Pharmacy Dispensing Site | — | NULL | Yes |

## Other

- **Enumeration date:** 06/16/2009
- **Last updated:** 09/23/2009