1164563235 NPI number — SIGNATURE HEALTHCARE SERVICES, I, LLC

Table of content: (NPI 1164563235)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164563235 NPI number — SIGNATURE HEALTHCARE SERVICES, I, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SIGNATURE HEALTHCARE SERVICES, I, 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:
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:
1164563235
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/06/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
590 E MAIN ST STE E
Provider Second Line Business Mailing Address:
P.O. BOX 3176
Provider Business Mailing Address City Name:
EAGLE PASS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78852-4772
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-758-1889
Provider Business Mailing Address Fax Number:
830-758-1714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
590 E MAIN ST STE E
Provider Second Line Business Practice Location Address:
SAME
Provider Business Practice Location Address City Name:
EAGLE PASS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78852-4772
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-758-1889
Provider Business Practice Location Address Fax Number:
830-758-1714
Provider Enumeration Date:
02/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DAWSON
Authorized Official First Name:
JOE
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
CEO, OWNER
Authorized Official Telephone Number:
830-758-1889

Provider Taxonomy Codes

  • Taxonomy code: 311Z00000X , with the licence number:  010320 , 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)





Copyright © 2007-2025 www.npivalidator.com