1154526044 NPI number — KERRVILLE AMBULATORY SURGERY CENTER, LLC

Table of content: (NPI 1154526044)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154526044 NPI number — KERRVILLE AMBULATORY SURGERY CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KERRVILLE AMBULATORY SURGERY CENTER, LLC
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:
1154526044
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 294868
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KERRVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78029-4868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-896-2444
Provider Business Mailing Address Fax Number:
830-896-2447

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 WATER ST
Provider Second Line Business Practice Location Address:
UNIT C
Provider Business Practice Location Address City Name:
KERRVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78028-3523
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-896-2444
Provider Business Practice Location Address Fax Number:
830-896-2447
Provider Enumeration Date:
06/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
CRAVEY
Authorized Official First Name:
RHONDA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
830-257-4417

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  008616 , 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: 197547601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: H0HH171A01 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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