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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