1346236924 NPI number — VINCENT P RASCON DPM

Table of content: VINCENT P RASCON DPM (NPI 1346236924)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346236924 NPI number — VINCENT P RASCON DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RASCON
Provider First Name:
VINCENT
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1346236924
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1913 HERITAGE BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79707-9752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-520-8396
Provider Business Mailing Address Fax Number:
432-520-3296

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1913 HERITAGE BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79707-9752
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-520-8396
Provider Business Practice Location Address Fax Number:
432-520-3296
Provider Enumeration Date:
09/20/2005

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: 213ES0103X , with the licence number:  1390 , 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: 122140100 . This is a "FIRSTCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 018575301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 162941201 . This is a "MEDICAID DME" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 480027409 . This is a "RR MCR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5927378 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 9686999 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0052CT . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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