1538101019 NPI number — ACS PRIMARY CARE PHYSICIANS SOUTHWEST, PA

Table of content: (NPI 1538101019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538101019 NPI number — ACS PRIMARY CARE PHYSICIANS SOUTHWEST, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACS PRIMARY CARE PHYSICIANS SOUTHWEST, 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:
1538101019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 HOPYARD RD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
PLEASANTON
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94588-3348
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-924-1600
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1900 HOSPITAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76240-2002
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-924-1600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HARDY
Authorized Official First Name:
SHARON
Authorized Official Middle Name:
Authorized Official Title or Position:
PROVIDER ENROLLMENT DIRECTOR
Authorized Official Telephone Number:
925-251-6901

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208M00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 170873704 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019LM . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DC7459 . This is a "MEDICARE RR - PALMETTO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DC8546 . This is a "PALMETTO GOVERNMENT BENEF" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 170873701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019LM . This is a "HMO BLUE - TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 170873702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0096MG . This is a "TEXAS BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DC7040 . This is a "PALMETTO GOVERNMENT BENEF" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 170873705 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD7728 . This is a "MEDICARE RR - PALMETTO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 009428900 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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