1154408540 NPI number — VASCULAR & GENERAL SURGERY ASSOCIATES PA

Table of content: (NPI 1154408540)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154408540 NPI number — VASCULAR & GENERAL SURGERY ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VASCULAR & GENERAL SURGERY ASSOCIATES PA
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:
1154408540
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 311130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRAUNFELS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78131-1130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-620-1191
Provider Business Mailing Address Fax Number:
830-620-1190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
191 N UNION AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEW BRAUNFELS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78130-4447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-620-1191
Provider Business Practice Location Address Fax Number:
830-620-1190
Provider Enumeration Date:
11/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
TILLY
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
LAWRENCE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
830-620-1191

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 020049264 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 143936601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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