1073638490 NPI number — SHARRON ACOSTA M.D.P.A.

Table of content: (NPI 1073638490)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073638490 NPI number — SHARRON ACOSTA M.D.P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHARRON ACOSTA M.D.P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
EYE ASSOCIATES OF SOUTH TEXAS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073638490
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 202293
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75320-2293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-379-9600
Provider Business Mailing Address Fax Number:
830-303-2222

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
908 E COURT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEGUIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78155-5813
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-379-3937
Provider Business Practice Location Address Fax Number:
830-379-2021
Provider Enumeration Date:
03/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GARZA
Authorized Official First Name:
RENEE
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIAL OFFICER
Authorized Official Telephone Number:
830-379-9600

Provider Taxonomy Codes

  • Taxonomy code: 207W00000X , with the licence number:  K2307 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 180043813 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 141567101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180041725 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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