1922079128 NPI number — DR. ERIC TIBLIER, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922079128 NPI number — DR. ERIC TIBLIER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. ERIC TIBLIER, 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:
1922079128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
901 W 38TH ST
Provider Second Line Business Mailing Address:
SUITE 400
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78705-1163
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-206-2988
Provider Business Mailing Address Fax Number:
512-206-2983

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
901 W 38TH ST
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78705-1163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-206-2988
Provider Business Practice Location Address Fax Number:
512-206-2983
Provider Enumeration Date:
01/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TIBLIER
Authorized Official First Name:
ERIC
Authorized Official Middle Name:
STUART
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
512-206-2988

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X , with the licence number:  J6767 , 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: 007MQ . This is a "BCBS OF TEXAS GROUP #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 173181201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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