1083664759 NPI number — BROWNSVILLE PULMONARY CENTER, P.A.

Table of content: (NPI 1083664759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083664759 NPI number — BROWNSVILLE PULMONARY CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROWNSVILLE PULMONARY CENTER, P.A.
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:
1083664759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
844 CENTRAL BLVD
Provider Second Line Business Mailing Address:
SUITE 420
Provider Business Mailing Address City Name:
BROWNSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78520-7552
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-542-9900
Provider Business Mailing Address Fax Number:
956-574-0003

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
844 CENTRAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 420
Provider Business Practice Location Address City Name:
BROWNSVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78520-7552
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-428-7862
Provider Business Practice Location Address Fax Number:
956-440-0395
Provider Enumeration Date:
05/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ
Authorized Official First Name:
JAIRO
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
956-542-9900

Provider Taxonomy Codes

  • Taxonomy code: 207RA0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 161983503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 161983504 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 161983502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0060GH . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 161983501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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