1518294776 NPI number — MCCRAE MANAGEMENT AND INVESTMENTS, 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 1518294776 NPI number — MCCRAE MANAGEMENT AND INVESTMENTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCCRAE MANAGEMENT AND INVESTMENTS, 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:
1518294776
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
26222 RR 12
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DRIPPING SPRINGS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78620-4903
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-858-0300
Provider Business Mailing Address Fax Number:
512-858-2714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12315 JUDSON RD STE 260
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LIVE OAK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78233-3203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-656-0327
Provider Business Practice Location Address Fax Number:
210-646-8330
Provider Enumeration Date:
11/09/2009

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
KIM
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF OPERATING OFFICER
Authorized Official Telephone Number:
512-858-0300

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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