1154631158 NPI number — TRIOVERSEAS VETERANS HEATHCARE PROVIDER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154631158 NPI number — TRIOVERSEAS VETERANS HEATHCARE PROVIDER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRIOVERSEAS VETERANS HEATHCARE PROVIDER
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:
1154631158
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
TRI OVERSEAS VETERANS HEALTH CARE PROVIDER
Provider Second Line Business Mailing Address:
RM, 504 PHYSICIANS CENTER, DR. R. POTENCIANO
Provider Business Mailing Address City Name:
MANDALUYONG CITY
Provider Business Mailing Address State Name:
163 EPIFANIO DELOS SANTOS AVE.
Provider Business Mailing Address Postal Code:
1550
Provider Business Mailing Address Country Code:
PH
Provider Business Mailing Address Telephone Number:
927-650-0014
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TRI OVERSEAS VETERANS HEALTH CARE PROVIDER
Provider Second Line Business Practice Location Address:
RM, 504 PHYSICIANS CENTER, DR. R. POTENCIANO
Provider Business Practice Location Address City Name:
MANDALUYONG CITY
Provider Business Practice Location Address State Name:
163 EPIFANIO DELOS SANTOS AVE.
Provider Business Practice Location Address Postal Code:
1550
Provider Business Practice Location Address Country Code:
PH
Provider Business Practice Location Address Telephone Number:
927-650-0014
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BANTANG
Authorized Official First Name:
RESENA
Authorized Official Middle Name:
MAYUGA
Authorized Official Title or Position:
NURSE-BILLER
Authorized Official Telephone Number:
927-650-0014

Provider Taxonomy Codes

  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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