1023676574 NPI number — SENSUS PSYCHIATRIC SOLUTIONS PLLC

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 1023676574 NPI number — SENSUS PSYCHIATRIC SOLUTIONS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SENSUS PSYCHIATRIC SOLUTIONS PLLC
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:
1023676574
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10250 JOHN SAUNDERS RD UNIT 460625
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:
78246-2420
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-468-2015
Provider Business Mailing Address Fax Number:
210-468-2355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8550 HUEBNER 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:
78240-1803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-541-5300
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/30/2019

Additional Information

Authorized Official

Authorized Official Last Name:
MICHELSEN
Authorized Official First Name:
SOAD
Authorized Official Middle Name:
Authorized Official Title or Position:
SOLE MBR
Authorized Official Telephone Number:
210-468-2015

Provider Taxonomy Codes

  • Taxonomy code: 2084P0804X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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