1942294939 NPI number — ST JOSEPH REGIONAL HEALTH CENTER

Table of content: SAPPHAIRE TERRELL (NPI 1639938830)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942294939 NPI number — ST JOSEPH REGIONAL HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ST JOSEPH REGIONAL HEALTH CENTER
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:
ST JOSEPH AMBULATORY SURGERY
Provider Other Organization Name Type Code:
5
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:
1942294939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 202536
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75320-2536
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-776-2426
Provider Business Mailing Address Fax Number:
979-776-5948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 FRANCISCAN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRYAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77802-2544
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-776-2426
Provider Business Practice Location Address Fax Number:
979-776-5948
Provider Enumeration Date:
09/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
TERESA
Authorized Official Middle Name:
Authorized Official Title or Position:
PATIENT FINANCIAL SERVICES MANAGER
Authorized Official Telephone Number:
979-776-2426

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 127267603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 094732702 . This is a "CIDC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 127267602 . This is a "HASC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4500498326 . This is a "CLIA" identifier . This identifiers is of the category "OTHER".




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