1710180286 NPI number — MS. MEGAN LYNN THIEDEMAN M.S.S.

Table of content: MS. MEGAN LYNN THIEDEMAN M.S.S. (NPI 1710180286)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710180286 NPI number — MS. MEGAN LYNN THIEDEMAN M.S.S.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THIEDEMAN
Provider First Name:
MEGAN
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.S.S.
Provider Gender Code:
F

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:
1710180286
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2533 GRAYSON WAY
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:
78232-1836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-478-5332
Provider Business Mailing Address Fax Number:
210-478-5384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9502 HUEBNER ROAD
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78240
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-478-5332
Provider Business Practice Location Address Fax Number:
210-478-5384
Provider Enumeration Date:
06/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2255A2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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