1487658050 NPI number — RGV-NUECES REHABILITATION, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487658050 NPI number — RGV-NUECES REHABILITATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RGV-NUECES REHABILITATION, INC.
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:
6
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:
1487658050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1329
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HELOTES
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78023-1329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-921-2111
Provider Business Mailing Address Fax Number:
210-921-2444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 PALO ALTO RD
Provider Second Line Business Practice Location Address:
SUITE 465
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78211-3758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-921-2111
Provider Business Practice Location Address Fax Number:
210-921-2444
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHANEN
Authorized Official First Name:
PETER
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
210-921-2111

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  629340000 , 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: I070440 . This is a "INTERPLAN HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 6400150 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10066488 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7712156 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0079DL . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 080735601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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