1295812683 NPI number — MRS. ANNE MEREDITH LATOUR PT

Table of content: MRS. ANNE MEREDITH LATOUR PT (NPI 1295812683)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295812683 NPI number — MRS. ANNE MEREDITH LATOUR PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LATOUR
Provider First Name:
ANNE
Provider Middle Name:
MEREDITH
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HILLER
Provider Other First Name:
ANNE
Provider Other Middle Name:
MEREDITH
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1295812683
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2203 BABCOCK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-4412
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-614-3911
Provider Business Mailing Address Fax Number:
210-616-0443

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2203 BABCOCK RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-4412
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-3911
Provider Business Practice Location Address Fax Number:
210-616-0443
Provider Enumeration Date:
11/01/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  1135358 , 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)