1821298225 NPI number — GASTROENTEROLOGY CONSULTANTS OF SAN ANTONIO, P.A.

Table of content: (NPI 1821298225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821298225 NPI number — GASTROENTEROLOGY CONSULTANTS OF SAN ANTONIO, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GASTROENTEROLOGY CONSULTANTS OF SAN ANTONIO, 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:
1821298225
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2778
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:
78299-2778
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-614-1234
Provider Business Mailing Address Fax Number:
210-614-0952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5223 HAMILTON WOLFE RD
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:
78229-4463
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-1234
Provider Business Practice Location Address Fax Number:
210-614-0952
Provider Enumeration Date:
07/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GUIRL
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
210-614-1234

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  8981 , 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: 8981 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: CJ2572 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00HV34 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 109472403 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7645694 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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