1326138058 NPI number — CHILDREN OF TEXAS PEDIATRICS, PA

Table of content: (NPI 1326138058)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326138058 NPI number — CHILDREN OF TEXAS PEDIATRICS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN OF TEXAS PEDIATRICS, PA
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:
1326138058
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10350 BANDERA RD STE 210
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:
78250-5616
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-688-0088
Provider Business Mailing Address Fax Number:
210-688-0089

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10350 BANDERA RD STE 210
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:
78250-5616
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-688-0088
Provider Business Practice Location Address Fax Number:
210-688-0089
Provider Enumeration Date:
10/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DONNEL
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/DOCTOR
Authorized Official Telephone Number:
210-688-0088

Provider Taxonomy Codes

  • Taxonomy code: 170100000X , with the licence number:  L5308 , 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: 100001798361 . This is a "HEALTHSCOPE INS." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 948825 . This is a "GALAXY INSURANCE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0077MD . This is a "BCBS GROUP#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 160504423727 . This is a "HUMANA INSURANCE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2100709 . This is a "FIRST HEALTH INS." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2314125 . This is a "UNITED HEALTHCARE INS." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2354469 . This is a "CIGNA INS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8R6760 . This is a "BCBS PROVIDER ID#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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