1043312515 NPI number — COASTAL GASTROENTEROLOGY ASSOCIATES, PA

Table of content: ANN MARIE SCHMIDT ANP (NPI 1942755533)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043312515 NPI number — COASTAL GASTROENTEROLOGY ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COASTAL GASTROENTEROLOGY ASSOCIATES, 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:
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:
1043312515
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1015 MEDICAL CENTER BLVD
Provider Second Line Business Mailing Address:
SUITE 1300
Provider Business Mailing Address City Name:
WEBSTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77598-4052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-557-2527
Provider Business Mailing Address Fax Number:
281-557-7203

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1015 MEDICAL CENTER BLVD
Provider Second Line Business Practice Location Address:
SUITE 1300
Provider Business Practice Location Address City Name:
WEBSTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77598-4052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-557-2527
Provider Business Practice Location Address Fax Number:
281-557-7203
Provider Enumeration Date:
09/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SUBRAMANYAM
Authorized Official First Name:
KALYANAM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
281-557-2527

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2226780 . This is a "BCBS - TX - BLUE LINK ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5283 . This is a "RR MCR GROUP NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4102895 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: P00440059 . This is a "RR MCR" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1164493870 . This is a "NPI - INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: B26780 . This is a "MCR UPIN - INDIVIDUAL" identifier . This identifiers is of the category "OTHER".
  • Identifier: 114758902 . This is a "THMP - DR. SUBRAMANYAM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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