1912235607 NPI number — MEDSURANT, LLC

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 1912235607 NPI number — MEDSURANT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDSURANT, LLC
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:
1912235607
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/30/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1141 N LOOP 1604 E STE 105-484
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:
78232-1339
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
484-351-8459
Provider Business Mailing Address Fax Number:
484-351-8810

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 FRONT ST
Provider Second Line Business Practice Location Address:
STE 280
Provider Business Practice Location Address City Name:
WEST CONSHOCKEN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19428
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
484-351-8459
Provider Business Practice Location Address Fax Number:
484-351-8810
Provider Enumeration Date:
11/18/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HOUFF
Authorized Official First Name:
STEPHEN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
484-351-8459

Provider Taxonomy Codes

  • Taxonomy code: 204D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: COB5404 . This is a "MEDICARE PTAN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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