1073023065 NPI number — SOUTH TEXAS ASC, LLC

Table of content: (NPI 1073023065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073023065 NPI number — SOUTH TEXAS ASC, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH TEXAS ASC, LLC
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:
SOUTH TEXAS SURGICAL INSTITUTE
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:
1073023065
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/20/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 780849
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:
78278-0849
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
855-882-2849
Provider Business Mailing Address Fax Number:
801-931-2044

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8122 DATAPOINT DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3264
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-200-6392
Provider Business Practice Location Address Fax Number:
210-200-6394
Provider Enumeration Date:
10/04/2017

Additional Information

Authorized Official

Authorized Official Last Name:
LONERGAN
Authorized Official First Name:
MEGAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATIONS OFFICER
Authorized Official Telephone Number:
210-695-2757

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: HH404A . This is a "BCBS PROVIDER ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com