Organization
TEXAS DEPARTMENT OF STATE HEALTH SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. BARBARA SUZANNE KELLY-KING (REVENUE MANAGEMENT UNIT MANAGER)
(512) 458-7111
Entity
Organization
Contact information
Practice address
1100 WEST 49TH STREET, AUSTIN, TX 78714-9347
(512) 458-7111
(512) 458-7588
Mailing address
1100 WEST 49TH STREET, P.O. BOX 149347, AUSTIN, TX 78714-9347
(512) 458-7111
(512) 458-7588
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
—
—
Other
Enumeration date
06/16/2009
Last updated
09/23/2009
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