1104981315 NPI number — ALAMO ASTHMA & ALLERGY ASSOCIATES, P.A.

Table of content: (NPI 1104981315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104981315 NPI number — ALAMO ASTHMA & ALLERGY ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAMO ASTHMA & ALLERGY ASSOCIATES, 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:
1104981315
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 156
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:
78291-0156
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-499-0033
Provider Business Mailing Address Fax Number:
210-404-0926

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
104 GALLERY CIR
Provider Second Line Business Practice Location Address:
SUITE 126
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-3329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-499-0033
Provider Business Practice Location Address Fax Number:
210-404-0926
Provider Enumeration Date:
12/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VAUGHN
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
P
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
210-499-0033

Provider Taxonomy Codes

  • Taxonomy code: 174400000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 133677801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 167435001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com