1063560654 NPI number — R. P. YURCHESHEN, PH.D., P.C.

Table of content: (NPI 1063560654)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063560654 NPI number — R. P. YURCHESHEN, PH.D., P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R. P. YURCHESHEN, PH.D., P.C.
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:
1063560654
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6391 DE ZAVALA RD STE 203C
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:
78249-2159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-734-6668
Provider Business Mailing Address Fax Number:
210-734-6660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6391 DE ZAVALA RD
Provider Second Line Business Practice Location Address:
STE 203C
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78249-2143
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-734-6668
Provider Business Practice Location Address Fax Number:
210-734-6660
Provider Enumeration Date:
01/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YURCHESHEN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
PAUL
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-734-6668

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  21782 , 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: 00JC51 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0341463-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 27739900 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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