1649232596 NPI number — FLATLAND MEDICAL ASSOCIATES

Table of content: (NPI 1649232596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649232596 NPI number — FLATLAND MEDICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FLATLAND MEDICAL ASSOCIATES
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:
1649232596
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 291386
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:
78029-1386
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-562-5961
Provider Business Mailing Address Fax Number:
254-562-2813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
514 S BONHAM ST
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
MEXIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76667-3600
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-562-5961
Provider Business Practice Location Address Fax Number:
254-562-2813
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MADRID
Authorized Official First Name:
ALBERTO
Authorized Official Middle Name:
Authorized Official Title or Position:
SURGEON
Authorized Official Telephone Number:
254-562-5961

Provider Taxonomy Codes

  • Taxonomy code: 208600000X , with the licence number:  G0465 , 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: 0026NJ . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com