1881965481 NPI number — SPURS LANE MEDICAL ASSOCIATES PA

Table of content: (NPI 1881965481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881965481 NPI number — SPURS LANE MEDICAL ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPURS LANE MEDICAL ASSOCIATES 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:
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:
1881965481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 SPURS LANE
Provider Second Line Business Mailing Address:
BLDG 6 STE 100
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78240-1634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-615-8003
Provider Business Mailing Address Fax Number:
210-615-1141

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 SPURS LANE
Provider Second Line Business Practice Location Address:
BLDG 6 STE 100
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78240-1634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-615-8003
Provider Business Practice Location Address Fax Number:
210-615-1141
Provider Enumeration Date:
01/13/2012

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
VOSBERG
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
LEE
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
210-615-8003

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  J0337 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RH0003X , with the licence number: L5719 , 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)