1134102403 NPI number — COMMUNITY HEALTH DEVELOPMENT INC.

Table of content: (NPI 1134102403)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134102403 NPI number — COMMUNITY HEALTH DEVELOPMENT INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY HEALTH DEVELOPMENT INC.
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:
OUR HEALTH - MEDICAL
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:
1134102403
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
908 EVANS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UVALDE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78801-6034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-278-5604
Provider Business Mailing Address Fax Number:
830-278-1836

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
200 EVANS ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UVALDE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78801-5142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-278-7105
Provider Business Practice Location Address Fax Number:
830-278-1836
Provider Enumeration Date:
11/21/2005

Additional Information

Authorized Official

Authorized Official Last Name:
CASTANON
Authorized Official First Name:
MAYELA
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
830-278-5604

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00FM20 . This is a "MEDICARE TRAILBLAZER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1851375224 . This is a "ROLAND PEREZ, PA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1710110457 . This is a "AMBRISH PATEL, PA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1871576868 . This is a "PROVIDER NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 111438102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1184685109 . This is a "JOHN PEREZ, PA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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