1275544207 NPI number — JOSE L ACEVES MD

Table of content: MRS. MARSHA D PERRYMAN RN,IBCLC,RLC (NPI 1912117532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275544207 NPI number — JOSE L ACEVES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ACEVES
Provider First Name:
JOSE
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1275544207
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/19/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
315 N SAN SABA STE 1135
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78207-3255
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-704-4275
Provider Business Mailing Address Fax Number:
210-704-4520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 N SANTA ROSA
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78207-3108
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-704-4708
Provider Business Practice Location Address Fax Number:
210-704-4952
Provider Enumeration Date:
08/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0402X , with the licence number:  J7741 , 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: 092139706 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 137345810 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 124023 . This is a "SUPERIOR PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8A9111 . This is a "BCBSTX IND PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 092139707 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5447047 . This is a "CIGNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1833530 . This is a "FIRSTHEALTH PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00U87Z . This is a "BCBSTX GRP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7309076 . This is a "AETNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10027042 . This is a "AMERIGROUP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1966795 . This is a "UHC PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 092139720 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 130116100 . This is a "FIRSTCARE PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 140442852 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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