1346652575 NPI number — CHRISTUS PEDIATRIC PHYSICIAN GROUP

Table of content: (NPI 1346652575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346652575 NPI number — CHRISTUS PEDIATRIC PHYSICIAN GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTUS PEDIATRIC PHYSICIAN GROUP
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:
CHILDREN'S HOSPITAL OF SAN ANTONIO PHYSICIAN GROUP
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:
1346652575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/27/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 NE LOOP 410
Provider Second Line Business Mailing Address:
SUITE 800
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78216-4700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-704-8706
Provider Business Mailing Address Fax Number:
210-704-4695

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 NE LOOP 410
Provider Second Line Business Practice Location Address:
SUITE 800
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78216
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-704-8706
Provider Business Practice Location Address Fax Number:
210-704-4695
Provider Enumeration Date:
05/22/2014

Additional Information

Authorized Official

Authorized Official Last Name:
KOTAL
Authorized Official First Name:
CLINTON
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
210-704-8706

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com