1093846248 NPI number — EAR INSTITUTE OF TEXAS P A

Table of content: (NPI 1093846248)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093846248 NPI number — EAR INSTITUTE OF TEXAS P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAR INSTITUTE OF TEXAS 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:
Provider Other Organization Name Type Code:
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:
1093846248
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18518 HARDY OAK BLVD
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-4271
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-696-4327
Provider Business Mailing Address Fax Number:
210-798-2509

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18518 HARDY OAK BLVD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-4271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-696-4327
Provider Business Practice Location Address Fax Number:
210-798-2509
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JACKSON
Authorized Official First Name:
LANCE
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
210-696-4327

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  L5777 , 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: 0036JV . This is a "BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00019999 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 157517701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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