1164563235 NPI number — SIGNATURE HEALTHCARE SERVICES, I, LLC

Table of Contents

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)





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