1215025598 NPI number — MEDCARE ASSOCIATES, P.A.

Table of content: (NPI 1215025598)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215025598 NPI number — MEDCARE ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDCARE ASSOCIATES, P.A.
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:
1215025598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2870
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANDERA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78003-2870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-796-7713
Provider Business Mailing Address Fax Number:
830-796-7744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 HIGHWAY 16 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANDERA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-796-7713
Provider Business Practice Location Address Fax Number:
830-796-7744
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRAZIER
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE ADMINISTRATOR
Authorized Official Telephone Number:
830-816-5700

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  K0839 , 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: 1215025598 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3347 . This is a "SUPERIOR HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 771 . This is a "COMMUNITY FIRST HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10002909 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2132872 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 191965261126 . This is a "HUMANA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 414865 . This is a "FIRST HEALTH/COVENTRY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0055BY . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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