1144328311 NPI number — H-E-B, LP

Table of content: DR. JAMES NEIL BOW PH.D. (NPI 1043391089)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144328311 NPI number — H-E-B, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
H-E-B, LP
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:
6
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:
1144328311
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
646 SOUTH FLORES
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:
78204
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3025 DOWLEN RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-860-4212
Provider Business Practice Location Address Fax Number:
409-861-2254
Provider Enumeration Date:
09/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LIENDO
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
GOVERNMENT PROGRAMS MANAGER
Authorized Official Telephone Number:
210-938-3182

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X , with the licence number: 25065 , 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: 469054 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4542696 . This is a "NCPDP PROVIDER IDENTIFICATION NUMBER" identifier . This identifiers is of the category "OTHER".




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