1033435037 NPI number — BHCFR SAN ANTONIO PA

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 1033435037 NPI number — BHCFR SAN ANTONIO PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BHCFR SAN ANTONIO PA
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:
REHABILITATION & PAIN CENTER, SAN ANTONIO
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:
1033435037
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/24/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 925185
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77292-5185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-586-6705
Provider Business Mailing Address Fax Number:
713-586-6752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18518 HARDY OAK BLVD
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-4759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-586-6705
Provider Business Practice Location Address Fax Number:
713-586-6752
Provider Enumeration Date:
04/15/2010

Additional Information

Authorized Official

Authorized Official Last Name:
KELLNER
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
C
Authorized Official Title or Position:
DIRECTOR OF MEDICAL CREDENTIALING
Authorized Official Telephone Number:
713-586-6705

Provider Taxonomy Codes

  • Taxonomy code: 208100000X , with the licence number:  801181007 , 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)





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