1992796742 NPI number — SAN ANTONIO ENDOSCOPY, LP

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 1992796742 NPI number — SAN ANTONIO ENDOSCOPY, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN ANTONIO ENDOSCOPY, 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 ANTONIO ENDOSCOPY 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:
1992796742
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8550 DATAPOINT DRIVE
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-3436
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-615-7232
Provider Business Mailing Address Fax Number:
210-615-6732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8550 DATAPOINT DRIVE
Provider Second Line Business Practice Location Address:
SUITE 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:
78229-3436
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-615-7232
Provider Business Practice Location Address Fax Number:
210-615-6732
Provider Enumeration Date:
11/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BLACH
Authorized Official First Name:
PETER
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER/AUTHORIZED OFFICIAL
Authorized Official Telephone Number:
713-343-9083

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  008225 , 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: HH005A . This is a "TEXAS BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1608226-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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