1356415004 NPI number — RADIATION ONCOLOGY ASSOCIATES OF SOUTH TEXAS, L.L.P.

Table of content: (NPI 1356415004)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356415004 NPI number — RADIATION ONCOLOGY ASSOCIATES OF SOUTH TEXAS, L.L.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RADIATION ONCOLOGY ASSOCIATES OF SOUTH TEXAS, L.L.P.
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:
ROAST
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:
1356415004
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1502 E RED RIVER ST
Provider Second Line Business Mailing Address:
#347
Provider Business Mailing Address City Name:
VICTORIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77901-5523
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-576-9812
Provider Business Mailing Address Fax Number:
361-574-1580

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2807 N BEN WILSON ST
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77901-5730
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-576-9812
Provider Business Practice Location Address Fax Number:
361-574-1580
Provider Enumeration Date:
11/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHEN
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
LING
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
361-576-9812

Provider Taxonomy Codes

  • Taxonomy code: 2085R0203X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00F16E . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1538248695 . This is a "KARL K. CHEN, M.D., NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: CS4948 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: E21013 . This is a "KARL K. CHEN, M.D., UPIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 082420301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1093894198 . This is a "DAVID L. JANSSEN, M.D., NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: A13659 . This is a "DAVID L. JANSSEN,MD, UPIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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