1003088931 NPI number — OMAR SAUCEDO EMT/HEALTHCARE SPC

Table of content: OMAR SAUCEDO EMT/HEALTHCARE SPC (NPI 1003088931)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003088931 NPI number — OMAR SAUCEDO EMT/HEALTHCARE SPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAUCEDO
Provider First Name:
OMAR
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
EMT/HEALTHCARE SPC
Provider Gender Code:
M

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:
1003088931
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
LYSTER ARMY HEALTH CLINIC
Provider Second Line Business Mailing Address:
BLDG 301 ANDREWS AVE
Provider Business Mailing Address City Name:
FORT RUCKER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
LYSTER ARMY HEALTH CLINIC
Provider Second Line Business Practice Location Address:
BLDG 301 ANDREWS AVE
Provider Business Practice Location Address City Name:
FORT RUCKER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36362
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-255-7894
Provider Business Practice Location Address Fax Number:
334-255-7490
Provider Enumeration Date:
04/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 146N00000X , with the licence number:  B1648501 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 376K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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