1124041462 NPI number — ALLSTAR PARTNERS LP

Table of content: (NPI 1124041462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124041462 NPI number — ALLSTAR PARTNERS LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALLSTAR PARTNERS LP
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:
1124041462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 PECAN ST W STE 8
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PFLUGERVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78660-2607
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-251-5977
Provider Business Mailing Address Fax Number:
512-251-6017

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 PECAN ST W STE 8
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PFLUGERVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78660-2607
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-251-5977
Provider Business Practice Location Address Fax Number:
512-251-6017
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
YULE
Authorized Official First Name:
JUSTIN
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
512-458-4589

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 001015004 . This is a "MDCP - REGION 5" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 144175001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001015009 . This is a "MDCP - REGION 10" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 016039201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107662205 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 532675 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001015006 . This is a "MDCP-REGION7" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001015007 . This is a "MDCP - REGION 8" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001015010 . This is a "MDCP - REGION 11" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 107662201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 001015008 . This is a "MDCP - REGION 9" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 016039202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 515064 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 107662204 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107662206 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 107662203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 532674 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 001015005 . This is a "MDCP- REGION 6" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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