1114024718 NPI number — UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO

Table of content: CAILLEY QUINN BEAN PTA (NPI 1740994789)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114024718 NPI number — UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF TEXAS HEALTH SCIENCE CENTER AT SAN ANTONIO
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:
6
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:
1114024718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/10/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8431 FREDERICKSBURG ROAD
Provider Second Line Business Mailing Address:
FLOOR 1
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-3392
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-450-9000
Provider Business Mailing Address Fax Number:
210-450-4903

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7703 FLOYD CURL DRIVE
Provider Second Line Business Practice Location Address:
6TH FLOOR - 638E
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-450-6470
Provider Business Practice Location Address Fax Number:
210-200-6315
Provider Enumeration Date:
09/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARKS
Authorized Official First Name:
ANDREA
Authorized Official Middle Name:
Authorized Official Title or Position:
VP & CFO
Authorized Official Telephone Number:
210-450-4621

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 335E00000X , with the licence number: 101005 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 086678201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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