1902236003 NPI number — DR. AV, PLLC

Table of content: (NPI 1902236003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902236003 NPI number — DR. AV, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DR. AV, PLLC
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:
DR. AV, PLLC
Provider Other Organization Name Type Code:
3
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:
1902236003
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 684905
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78768-4905
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-787-6621
Provider Business Mailing Address Fax Number:
512-904-5603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 LEE BARTON DR
Provider Second Line Business Practice Location Address:
UNIT # 206
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-1045
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-787-6621
Provider Business Practice Location Address Fax Number:
512-904-5603
Provider Enumeration Date:
11/26/2013

Additional Information

Authorized Official

Authorized Official Last Name:
VIDACIC
Authorized Official First Name:
ALEKSANDRA
Authorized Official Middle Name:
Authorized Official Title or Position:
HEALTHCARE PROFESSIONAL
Authorized Official Telephone Number:
210-787-6621

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  N4181 , 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)





Copyright © 2007-2024 www.npivalidator.com