1164422143 NPI number — SAN ANTONIO EXTENDED MEDICAL CARE, INC.

Table of content: (NPI 1164422143)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164422143 NPI number — SAN ANTONIO EXTENDED MEDICAL CARE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN ANTONIO EXTENDED MEDICAL CARE, INC.
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:
1164422143
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/10/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
21195 IH 10 W
Provider Second Line Business Mailing Address:
SUITE 1101
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78257-1674
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-697-9933
Provider Business Mailing Address Fax Number:
210-697-8753

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
21195 IH 10 W
Provider Second Line Business Practice Location Address:
SUITE 1101
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78257-1674
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-697-9933
Provider Business Practice Location Address Fax Number:
210-697-8753
Provider Enumeration Date:
07/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BARRERA
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-697-9933

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BP3500X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , 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: 0156986-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1023589 . This is a "ACM PRIMARY & SECONDARY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 508280 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0867822-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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