Organization
HEALTH AND HUMAN SERVICES COMMISSION
Active
Other names
Rusk State Hospital
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. JANA JOHNSON (ACCOUNTANT III)
(512) 206-5284
Entity
Organization
Contact information
Practice address
805 NORTH DICKINSON, RUSK, TX 75785-0318
(903) 683-7201
(903) 683-7199
Mailing address
4110 GUADALUPE ST, HOSPITAL REVENUE MGMT-MC2023, AUSTIN, TX 78751-4223
(512) 206-5284
(512) 206-5302
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
TX
103TC0700X
Clinical Psychologist
—
TX
183500000X
Pharmacist
—
TX
2084F0202X
Forensic Psychiatry Physician
—
TX
2084N0400X
Neurology Physician
—
TX
2084P0800X
Psychiatry Physician
—
TX
2084P0804X
Child & Adolescent Psychiatry Physician
—
TX
2084P0805X
Geriatric Psychiatry Physician
—
TX
208D00000X
General Practice Physician
—
TX
363A00000X
Physician Assistant
—
TX
363L00000X
Nurse Practitioner
—
TX
364S00000X
Clinical Nurse Specialist
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0638231-01
—
TX
05
—
0827925-01
—
TX
05
—
1333312-01
—
TX
05
—
1333312-02
—
TX
05
—
1333312-03
—
TX
01
—
4537835
PHARMACY NCPDP
TX
01
—
HH3006
BCBS DRUG/ALCOHOL
TX
01
—
HH4588
BCBS PSYCHIATRIC
TX
Enumeration date
08/15/2006
Last updated
08/25/2017
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