1699382663 NPI number — A-V SUPPORT SERVICES

Table of content: DR. SEAN HARRISON KREITZER DPT (NPI 1871203851)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699382663 NPI number — A-V SUPPORT SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
A-V SUPPORT SERVICES
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:
1699382663
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
06/10/2022
NPI Reactivation Date:
07/13/2022

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4302 FIRST VIEW DR
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:
78217-3634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-837-7735
Provider Business Mailing Address Fax Number:
210-245-6697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4302 FIRST VIEW DR
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:
78217-3634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-837-7735
Provider Business Practice Location Address Fax Number:
210-245-6697
Provider Enumeration Date:
09/24/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VARGAS
Authorized Official First Name:
EDUARDO
Authorized Official Middle Name:
ANDRES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
210-837-7735

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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