1336139633 NPI number — CITY OF SHAVANO PARK

Table of content: (NPI 1336139633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336139633 NPI number — CITY OF SHAVANO PARK

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF SHAVANO PARK
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:
1336139633
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/28/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15604 NW MILITARY HWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHAVANO PARK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78231-1537
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-492-1111
Provider Business Mailing Address Fax Number:
210-492-5884

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15604 NW MILITARY HWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHAVANO PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78231-1537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-492-1111
Provider Business Practice Location Address Fax Number:
210-492-5884
Provider Enumeration Date:
10/27/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MOREY
Authorized Official First Name:
BRENDA
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
210-477-0960

Provider Taxonomy Codes

  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 3416L0300X , with the licence number: 015108 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 171420601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: AMB418 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".