1235286972 NPI number — WOMEN'S CLINIC OF DIMMIT AND ZAVALA P.A.

Table of content: (NPI 1235286972)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235286972 NPI number — WOMEN'S CLINIC OF DIMMIT AND ZAVALA P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WOMEN'S CLINIC OF DIMMIT AND ZAVALA 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:
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:
1235286972
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
706 HOSPITAL DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARRIZO SPRINGS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78834-3836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-876-9625
Provider Business Mailing Address Fax Number:
830-876-5752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
523 W ZAVALA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CRYSTAL CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78839-2828
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-374-3118
Provider Business Practice Location Address Fax Number:
830-876-5752
Provider Enumeration Date:
01/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUTLER
Authorized Official First Name:
MICHEAL
Authorized Official Middle Name:
ANTHONY
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
830-876-9625

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 157874202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00212R . This is a "MEDICARE GROUP #" identifier . This identifiers is of the category "OTHER".




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