1124102371 NPI number — DR. SAMUEL JOSEPH KASBERG M.D.

Table of content: DR. SAMUEL JOSEPH KASBERG M.D. (NPI 1124102371)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124102371 NPI number — DR. SAMUEL JOSEPH KASBERG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KASBERG
Provider First Name:
SAMUEL
Provider Middle Name:
JOSEPH
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1124102371
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/16/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2438 INDUSTRIAL BLVD
Provider Second Line Business Mailing Address:
PMB 105
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79605-7207
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-947-6960
Provider Business Mailing Address Fax Number:
325-947-6968

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 KNICKERBOCKER
Provider Second Line Business Practice Location Address:
SAN ANGELO COMMUNITY MEDICAL CENTER
Provider Business Practice Location Address City Name:
SAN ANGELO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76904-7698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-947-6960
Provider Business Practice Location Address Fax Number:
325-947-6968
Provider Enumeration Date:
10/24/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207PE0005X , with the licence number:  J3826 , 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: P00244052 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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