BLUEBONNET TRAILS COMMUNITY MHMR CENTER NPI 1518536309

NPI Information

NPI: 1518536309
Provider Name: BLUEBONNET TRAILS COMMUNITY MHMR CENTER

Doing Business As: BLUEBONNET TRAILS COMMUNITY SERVICES

Classification: Clinic/Center - 261QR1300X
Entity Type: Organization

Specialization: Rural Health

Address:
750 W TRAVIS ST
LA GRANGE, TX
ZIP 78945
Phone: (512) 255-1720
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BLUEBONNET TRAILS COMMUNITY MHMR CENTER is a rural health clinic center in La Grange, TX. BLUEBONNET TRAILS COMMUNITY MHMR CENTER NPI is 1518536309. The provider is registered as an organization entity type.
The provider Is Doing Business As Bluebonnet Trails Community Services.

The provider's business location address is:

750 W TRAVIS ST
LA GRANGE, TX
ZIP 78945-522
Phone: (512) 255-1720
Fax: (512) 244-8401

The provider's authorized official is Andrea Richardson .
The authorized official title is Executive Director and has the following contact phone number (512) 244-8305.

The CLIA number assigned to this NPI record is 45D1104766 - community clinic with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 6/24/2021 and was last updated on 8/25/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QR1300X	Clinic/Center	Rural Health			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	1268443-05	MEDICAID	TEXAS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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