1891751285 NPI number — MRS. RACHEL L. CIESLEWICZ PA-C

Table of content: MRS. RACHEL L. CIESLEWICZ PA-C (NPI 1891751285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891751285 NPI number — MRS. RACHEL L. CIESLEWICZ PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CIESLEWICZ
Provider First Name:
RACHEL
Provider Middle Name:
L.
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1891751285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 REGIONAL MEDICAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WHARTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77488-9719
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-532-1700
Provider Business Mailing Address Fax Number:
979-532-4584

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2520 B F TERRY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSENBERG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77471-5636
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-342-6006
Provider Business Practice Location Address Fax Number:
281-239-7554
Provider Enumeration Date:
04/25/2006

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: 363A00000X , with the licence number:  PA02539 , 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: 970028617 . This is a "RAILROAD GBA - RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P01090440 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 306204402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 875N28 . This is a "BC/BS #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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