Organization
SUMMIT MENTAL HEALTH CLINIC PA
Active
Organization
SUMMIT MENTAL HEALTH CLINIC PA
Active
Other names
Summit Mental Health Clinic PA
Organization subpart
No
Provider details
NPI number
Authorized official
DR. FRANCISCA ADA IFESINACHUKWU M.D. (MEDICAL DIRECTOR/PRESIDENT)
(512) 732-2122
Entity
Organization
Contact information
Practice address
4131 SPICEWOOD SPRINGS RD, BLDG#L, #2, AUSTIN, TX 78759-8661
(512) 732-2122
Mailing address
PO BOX 17906, AUSTIN, TX 78760-7906
(512) 732-2122
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
L1620
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00773X
MEDICARE GROUP #
TX
05
—
153758102
—
TX
01
—
173311501
TPI
TX
Enumeration date
03/10/2008
Last updated
03/10/2008
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