1366626517 NPI number — KERRVILLE MEDICAL SERVICES, PA

Table of content: DR. SANDRA LEE ZUCKER SALAN M.D. (NPI 1376664060)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366626517 NPI number — KERRVILLE MEDICAL SERVICES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERRVILLE MEDICAL SERVICES, PA
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:
1366626517
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/24/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1365 SADDLEWOOD BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KERRVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78028-7231
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-238-6123
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 LA HACIENDA WAY
Provider Second Line Business Practice Location Address:
LA HACIENDA TREATMENT CENTER
Provider Business Practice Location Address City Name:
HUNT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-238-6123
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOONE
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
PRESIDENT, KERRVILLE MEDICAL SERVIC
Authorized Official Telephone Number:
830-238-6123

Provider Taxonomy Codes

  • Taxonomy code: 207RA0401X , with the licence number:  F6460 , 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)





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