1285639419 NPI number — DR. JAMES JOSEPH SORCE MD

Table of content: (NPI 1679501837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285639419 NPI number — DR. JAMES JOSEPH SORCE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SORCE
Provider First Name:
JAMES
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
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:
1285639419
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28505 SHAILENE DR
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:
78260-1446
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-648-1119
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 STEVE HAWKINS PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARBLE FALLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78654-6303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-992-2830
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2005

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: 207Y00000X , with the licence number:  K1070 , 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: 109800 . This is a "SUPERIOR HEALTH PLANS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8454J3 . This is a "BC/BS TX NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 130520301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 176590500 . This is a "WORKERS COMPENSATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 040010464 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 130520307 . This is a "CIDC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 134649100 . This is a "VALLEY HEALTH PLANS NUMBE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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