1861730939 NPI number — FAMILY HEALTH OF SOUTH TEXAS, PA

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 1861730939 NPI number — FAMILY HEALTH OF SOUTH TEXAS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY HEALTH OF SOUTH TEXAS, PA
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:
6
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:
1861730939
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4522 FREDERICKSBURG RD STE A5
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:
78201-6517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-692-7171
Provider Business Mailing Address Fax Number:
210-277-7460

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4522 FREDERICKSBURG RD STE A5
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78201-6517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-692-7171
Provider Business Practice Location Address Fax Number:
210-277-7460
Provider Enumeration Date:
01/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
ESQUIVEL
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
I
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-682-9434

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 337495103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 337495101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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