1235354507 NPI number — SERGIO G. PRECIADO, M.D., P.A.

Table of content: (NPI 1235354507)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235354507 NPI number — SERGIO G. PRECIADO, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SERGIO G. PRECIADO, M.D., 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:
PHARR KID'S CLINIC
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:
1235354507
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
832 DEL ORO
Provider Second Line Business Mailing Address:
SUITE 2
Provider Business Mailing Address City Name:
PHARR
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78577-2200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-787-2500
Provider Business Mailing Address Fax Number:
956-787-2528

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
832 DEL ORO
Provider Second Line Business Practice Location Address:
SUITE 2
Provider Business Practice Location Address City Name:
PHARR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78577-2200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-787-2500
Provider Business Practice Location Address Fax Number:
956-787-2528
Provider Enumeration Date:
04/13/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PRECIADO
Authorized Official First Name:
SERGIO
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
956-787-2500

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  J9278 , 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: 1840126 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8X5070 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com