1609066257 NPI number — SAROJINI BOSE MD PA

Table of content: (NPI 1609066257)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609066257 NPI number — SAROJINI BOSE MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAROJINI BOSE MD 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:
ASHLEY HEALTH
Provider Other Organization Name Type Code:
3
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:
1609066257
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/28/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 E NOLANA AVE STE 13A
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78504-6112
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-686-2700
Provider Business Mailing Address Fax Number:
956-686-2708

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 E NOLANA AVE STE 13A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCALLEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78504-6112
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-686-2700
Provider Business Practice Location Address Fax Number:
956-686-2708
Provider Enumeration Date:
07/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOSE
Authorized Official First Name:
SAROJINI
Authorized Official Middle Name:
G
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-686-2700

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  L3248 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 158413803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158413805 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148015404 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148015413 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158413802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203222902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148015412 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148015401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158413806 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158413807 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 203222903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 217147202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148015403 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148015406 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148015409 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148015414 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158413804 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148015405 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 158413801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 148015402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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