1417965179 NPI number — JORGE L RINCON MD FACS PA

Table of content: (NPI 1417965179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417965179 NPI number — JORGE L RINCON MD FACS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JORGE L RINCON MD FACS 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:
1417965179
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/26/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 792424
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:
78279-2424
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-683-8776
Provider Business Mailing Address Fax Number:
210-745-0990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1162 E SONTERRA BLVD STE 210
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-4049
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-587-7744
Provider Business Practice Location Address Fax Number:
210-745-0990
Provider Enumeration Date:
08/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RINCON
Authorized Official First Name:
JORGE
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-587-7744

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  L8172 , 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: 179313501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0085NR . This is a "BCBS GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: L8172 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 051736 . This is a "ECFMG NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1356303960 . This is a "NPI INDIVIDUAL NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8V9840 . This is a "BCBS INVIDUAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 179314301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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