1033203393 NPI number — CENTER FOR DISEASE DETECTION LLC

Table of content: (NPI 1033203393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033203393 NPI number — CENTER FOR DISEASE DETECTION LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR DISEASE DETECTION 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:
1033203393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/14/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 659509
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:
78265-9509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-590-3033
Provider Business Mailing Address Fax Number:
210-590-3121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11603 CROSSWINDS WAY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78233-6005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-590-3033
Provider Business Practice Location Address Fax Number:
210-590-3121
Provider Enumeration Date:
10/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILLIAMS
Authorized Official First Name:
KIMBERLY
Authorized Official Middle Name:
T
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
800-222-7566

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0793742 . This is a "COLORADO MEDICAID" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".
  • Identifier: XLAB60475 . This is a "CALIFORNIA MEDI-CAL" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 033332 . This is a "FAMILY HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 095210302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 095210302 . This is a "AMERIGROUP TEXAS INC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 003126019 . This is a "CONNECTICUT" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7106123 . This is a "ADAPTIS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 565848 . This is a "CCN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 730813 . This is a "BUCKEYE COMMUNITY PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 976813 . This is a "ARIZONA MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: CL5132 . This is a "BLUECROSS BLUESHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: LB142TX . This is a "ALASKA MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 20039659 . This is a "AMERIHEALTH MERCY" identifier . This identifiers is of the category "OTHER".
  • Identifier: 690000009 . This is a "ALABAMA MEDICAID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 156260709 . This is a "ARKANSAS MEDICAID" identifier , issued by the state of ( AR ) . This identifiers is of the category "OTHER".
  • Identifier: 232921142000 . This is a "CARESOURCE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 031637700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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