| Earle | |
|
4100 Avenue D Austin TX 78751 | |
| (855) 553-2783 | |
| (855) 553-2783 |
| Full Name | Earle |
|---|---|
| Speciality | Social Worker |
| Location | 4100 Avenue D, Austin, Texas |
| Authorized Official Name and Position | Charles Jason Earle (DIRECTOR) |
| Authorized Official Contact | 8555532783 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Earle 1101 W 34th St Ste 256 Austin TX 78705-1907 Ph: (855) 553-2753 | Earle 4100 Avenue D Austin TX 78751 Ph: (855) 553-2783 |
| NPI Number | 1518330554 |
|---|---|
| Provider Enumeration Date | 11/12/2015 |
| Last Update Date | 01/22/2025 |
| Certification Date | 01/10/2025 |
| Medicare PECOS PAC ID | 1254632755 |
|---|---|
| Medicare Enrollment ID | O20151228001487 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518330554 | NPI | - | NPPES |
| Provider Name | Charles Jason Earle |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1295173672 PECOS PAC ID: 9739320235 Enrollment ID: I20130725000703 |
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