1720092885 NPI number — FRANK C KRETSINGER D.O.

Table of content: FRANK C KRETSINGER D.O. (NPI 1720092885)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720092885 NPI number — FRANK C KRETSINGER D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KRETSINGER
Provider First Name:
FRANK
Provider Middle Name:
C
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

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:
1720092885
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 N VETERANS BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EAGLE PASS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78852-3302
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-773-8917
Provider Business Mailing Address Fax Number:
830-773-1892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
202 JAMES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BRACKETTVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78832-5117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-563-2434
Provider Business Practice Location Address Fax Number:
855-729-6740
Provider Enumeration Date:
07/27/2006

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: 207Q00000X , with the licence number:  F6841 , 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: 041409 . This is a "AMERICAN BOARD OF FAMILY MEDICINE" identifier , issued by the state of ( KY ) . This identifiers is of the category "OTHER".
  • Identifier: 8095B0 . This is a "MEDICARE PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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