1265475891 NPI number — TEJAS PEDIATRICS, P.A.

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 1265475891 NPI number — TEJAS PEDIATRICS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEJAS PEDIATRICS, 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:
1265475891
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20642 STONE OAK PKWY
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-7362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-479-3000
Provider Business Mailing Address Fax Number:
210-479-3016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20642 STONE OAK PKWY
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-7362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-479-3000
Provider Business Practice Location Address Fax Number:
210-479-3016
Provider Enumeration Date:
06/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
QUIROGA
Authorized Official First Name:
YVONNE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRACTICE ADMINISTRATOR
Authorized Official Telephone Number:
210-479-3000

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 045296302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1790876225 . This is a "DR. TREXLER NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0015EZ . This is a "BC CLINIC NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1629011242 . This is a "BEATTY NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1780627919 . This is a "BAUER NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1528009776 . This is a "STORANDT NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 173321401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 173321402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 218136401 . This is a "MEDICAID DR. HENIGAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 169952201 . This is a "MEDICAID DR. STORANDT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 111761604 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1194907183 . This is a "DR. HENIGAN NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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