1053317362 NPI number — DOCTORS HOSPITAL AT RENAISSANCE, LTD

Table of content: (NPI 1053317362)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053317362 NPI number — DOCTORS HOSPITAL AT RENAISSANCE, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS HOSPITAL AT RENAISSANCE, LTD
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:
DAY SURGERY AT RENAISSANCE
Provider Other Organization Name Type Code:
4
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:
1053317362
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3293
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCALLEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78502-3293
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-362-8677
Provider Business Mailing Address Fax Number:
956-362-3372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5501 S MCCOLL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EDINBURG
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78539-9152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-362-3300
Provider Business Practice Location Address Fax Number:
956-362-3372
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BECKMAN
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
V
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
956-362-3065

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 007971 , 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: 160709501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 160709504 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 160709502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: HH1032 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 115610600 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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