1164413340 NPI number — AMELIA VENDRELL MD

Table of content: AMELIA VENDRELL MD (NPI 1164413340)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164413340 NPI number — AMELIA VENDRELL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VENDRELL
Provider First Name:
AMELIA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1164413340
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 164106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78716-4106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-324-7516
Provider Business Mailing Address Fax Number:
512-324-7536

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 E 15TH ST
Provider Second Line Business Practice Location Address:
PATHOLOGY DEPARTMENT
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78701
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-324-7516
Provider Business Practice Location Address Fax Number:
512-324-7536
Provider Enumeration Date:
11/04/2005

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: 207ZP0102X , with the licence number:  H4767 , 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: 124426106 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 124426103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 124426105 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 124426107 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80P650 . This is a "BCBS OF TEXAS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 124426102 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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