1598914798 NPI number — ALAMO PAIN CENTER, P.A

Table of content: (NPI 1598914798)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598914798 NPI number — ALAMO PAIN CENTER, P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAMO PAIN CENTER, 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:
1598914798
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/14/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4346, DEPT 588
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77210-4346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-654-7246
Provider Business Mailing Address Fax Number:
210-654-7247

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12709 TOEPPERWEIN RD
Provider Second Line Business Practice Location Address:
STE 300
Provider Business Practice Location Address City Name:
LIVE OAK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78233-3258
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-654-7246
Provider Business Practice Location Address Fax Number:
210-654-7247
Provider Enumeration Date:
09/11/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GABRIEL
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-654-7246

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  M3814 , 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: 0026RT . This is a "BLUECROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com