1942290267 NPI number — TEXAS SAN MARCOS TREATMENT CENTER, LP

Table of content: (NPI 1942290267)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942290267 NPI number — TEXAS SAN MARCOS TREATMENT CENTER, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS SAN MARCOS TREATMENT CENTER, LP
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:
SAN MARCOS TREATMENT CENTER
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:
1942290267
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 BERT BROWN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN MARCOS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78666-5803
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-396-8500
Provider Business Mailing Address Fax Number:
512-754-3881

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 BERT BROWN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN MARCOS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78666-5803
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-396-8500
Provider Business Practice Location Address Fax Number:
512-754-3881
Provider Enumeration Date:
10/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FILTON
Authorized Official First Name:
STEVE
Authorized Official Middle Name:
Authorized Official Title or Position:
SRVP CFO
Authorized Official Telephone Number:
610-768-3300

Provider Taxonomy Codes

  • Taxonomy code: 323P00000X , with the licence number:  827335 , 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)

  • Identifier: 149375125 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0012310 , issued by the state of ( IA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00220476 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 796089 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: HS858PI , issued by the state of ( AK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0019433700001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 01560 , issued by the state of ( ND ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119451 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 006388550 , issued by the state of ( NV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 09276327 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200032940A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1228447-00 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4101692 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 45002128 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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