1902067028 NPI number — ADHD PLUS INC

Table of content: (NPI 1902067028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902067028 NPI number — ADHD PLUS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADHD PLUS INC
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:
ADHD PLUS
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:
1902067028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1370 PANTHEON WAY STE 250
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:
78232-2290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-403-2343
Provider Business Mailing Address Fax Number:
210-403-2350

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1370 PANTHEON WAY
Provider Second Line Business Practice Location Address:
STE 250
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78232-2290
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-403-2343
Provider Business Practice Location Address Fax Number:
210-403-2350
Provider Enumeration Date:
06/20/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PENKAVA
Authorized Official First Name:
JERI
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
210-403-2343

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 204D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2080P0006X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 121517009 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".