Provider Demographics
NPI:1932440245
Name:TRAVIS COUNTY EMPLOYEE WELLNESS & HEALTH
Entity type:Organization
Organization Name:TRAVIS COUNTY EMPLOYEE WELLNESS & HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM. ASSIST
Authorized Official - Prefix:
Authorized Official - First Name:IMAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:HAMMOUDEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:512-854-5509
Mailing Address - Street 1:1010 LAVACA ST # 221
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-2331
Mailing Address - Country:US
Mailing Address - Phone:512-854-5509
Mailing Address - Fax:512-854-4480
Practice Address - Street 1:1010 LAVACA ST # 221
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78701-2331
Practice Address - Country:US
Practice Address - Phone:512-854-5509
Practice Address - Fax:512-854-4480
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TRAVIS COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-03-12
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM3754208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Single Specialty