1831429372 NPI number — AAVERLEE CLINICAL ASSOCIATES

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 1831429372 NPI number — AAVERLEE CLINICAL ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
AAVERLEE CLINICAL 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:
1831429372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 61274
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78466-1274
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-814-2273
Provider Business Mailing Address Fax Number:
361-814-2274

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5801 PATTON ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78414-2457
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-814-2273
Provider Business Practice Location Address Fax Number:
361-814-2274
Provider Enumeration Date:
01/06/2010

Additional Information

Authorized Official

Authorized Official Last Name:
PFEIFFER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
BENEDICT
Authorized Official Title or Position:
SOCIAL WORKER
Authorized Official Telephone Number:
361-814-2273

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  16509 , 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: 119744403 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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