1861503856 NPI number — DR. MARK D. SOUCY PHD, RN, CNS-BC P/MH

Table of content: DR. MARK D. SOUCY PHD, RN, CNS-BC P/MH (NPI 1861503856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861503856 NPI number — DR. MARK D. SOUCY PHD, RN, CNS-BC P/MH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SOUCY
Provider First Name:
MARK
Provider Middle Name:
D.
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHD, RN, CNS-BC P/MH
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:
1861503856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7703 FLOYD CURL DR
Provider Second Line Business Mailing Address:
DEPARTMENT OF FAMILY NURSING CARE MAIL CODE 7951
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-3901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-269-8651
Provider Business Mailing Address Fax Number:
210-567-5822

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7703 FLOYD CURL DR
Provider Second Line Business Practice Location Address:
DEPARTMENT OF FAMILY NURSING CARE MAIL CODE 7951
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-567-5893
Provider Business Practice Location Address Fax Number:
210-567-5822
Provider Enumeration Date:
08/31/2006

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: 363LP0808X , with the licence number:  022528-23-08 , registered in the state of NH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0808X , with the licence number: 599005 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 364SP0807X , with the licence number: 599005 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0809X , with the licence number: 599005 , 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: 890000755 . This is a "MEDICARE RAILROAD PROVIDE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: NP7250 . This is a "BCBSTX PAR (SOLO)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: SO085N754 . This is a "BLUE SHIELD ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8N3781 . This is a "BCBS EXISTING PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: SO085N754 . This is a "BC/BS PROVIDER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".