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4131 Spicewood Springs Rd Bldg#l, #2 Austin TX 78759-8661 | |
(512) 732-2122 | |
Not Available |
Full Name | |
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Speciality | Clinic/Center |
Location | 4131 Spicewood Springs Rd, Austin, Texas |
Authorized Official Name and Position | Francisca Ada Ifesinachukwu (MEDICAL DIRECTOR/PRESIDENT) |
Authorized Official Contact | 5127322122 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 17906 Austin TX 78760-7906 Ph: (512) 732-2122 | 4131 Spicewood Springs Rd Bldg#l, #2 Austin TX 78759-8661 Ph: (512) 732-2122 |
NPI Number | 1699945360 |
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Provider Enumeration Date | 03/10/2008 |
Last Update Date | 03/10/2008 |
Medicare PECOS PAC ID | 5890752315 |
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Medicare Enrollment ID | O20041216000484 |
Identifier | Type | State | Issuer |
---|---|---|---|
1699945360 | NPI | - | NPPES |
00773X | Other | TX | MEDICARE GROUP # |
153758102 | Medicaid | TX | |
173311501 | Other | TX | TPI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261Q00000X | Clinic/center | L1620 (Texas) | Primary |
Provider Name | Francisca A Ifesinachukwu |
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Provider Type | Practitioner - Psychiatry |
Provider Identifiers | NPI Number: 1558475335 PECOS PAC ID: 5799742219 Enrollment ID: I20041220000045 |
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