1033203393 NPI number — CENTER FOR DISEASE DETECTION 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 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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