1508866138 NPI number — METROCARE SERVICES - AUSTIN

Table of content: (NPI 1508866138)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508866138 NPI number — METROCARE SERVICES - AUSTIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METROCARE SERVICES - AUSTIN
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:
1508866138
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 26018
Provider Second Line Business Mailing Address:
DEPARTMENT 8002
Provider Business Mailing Address City Name:
BEAUMONT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77720-6018
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-691-8906
Provider Business Mailing Address Fax Number:
325-691-1547

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4100 ED BLUESTEIN BLVD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78721-2300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-389-2144
Provider Business Practice Location Address Fax Number:
512-693-8277
Provider Enumeration Date:
07/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
KNUPPLE
Authorized Official First Name:
GEORGE
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
325-691-8906

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  300504 , 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: AMB641 . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00083967 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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