Provider Demographics
NPI:1194161968
Name:TEXAS HEALTH & SCIENCE UNIVERSITY PROFESSIONAL CLINIC
Entity type:Organization
Organization Name:TEXAS HEALTH & SCIENCE UNIVERSITY PROFESSIONAL CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT, CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:LIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-914-8888
Mailing Address - Street 1:1707 FORTVIEW RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7620
Mailing Address - Country:US
Mailing Address - Phone:512-445-2222
Mailing Address - Fax:
Practice Address - Street 1:1707 FORTVIEW RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78704-7620
Practice Address - Country:US
Practice Address - Phone:512-445-2222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TEXAS HEALTH & SCIENCE UNIVERSITY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-05-20
Last Update Date:2013-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAC01408171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty