Provider Demographics
NPI:1144862475
Name:TEXAS HEALTH AND SCIENCE UNIVERSITY
Entity type:Organization
Organization Name:TEXAS HEALTH AND SCIENCE UNIVERSITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JUE
Authorized Official - Middle Name:
Authorized Official - Last Name:GONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-919-7353
Mailing Address - Street 1:4005 MANCHACA RD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-6737
Mailing Address - Country:US
Mailing Address - Phone:512-444-8082
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:512-912-8484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-08
Last Update Date:2019-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty