1861497448 NPI number — UVALDE FAMILY PRACTICE ASSOC.

Table of content: (NPI 1861497448)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861497448 NPI number — UVALDE FAMILY PRACTICE ASSOC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UVALDE FAMILY PRACTICE ASSOC.
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:
1861497448
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 GARNER FIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
UVALDE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78801-6210
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-278-4453
Provider Business Mailing Address Fax Number:
830-278-3427

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 GARNER FIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
UVALDE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78801-6210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-278-4453
Provider Business Practice Location Address Fax Number:
830-278-3427
Provider Enumeration Date:
06/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SANCHEZ
Authorized Official First Name:
ELMA
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
830-278-4453

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  G6787 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207Q00000X , with the licence number: H0376 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 291U00000X , with the licence number: 45D0506268 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 017801401 . This is a "AMERIGROUP INS." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 017801401 . This is a "MOLINA INS." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 126866602 . This is a "SUPERIOR HEALTHPLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 083850001 . This is a "SUPERIOR HEALTHPLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 083850001 . This is a "MOLINA HEALTH INS." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 083850001 . This is a "AMERIGROUP INS." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 135092804 . This is a "SUPERIOR HEALTHPLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 017801401 . This is a "SUPERIOR HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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