1174729560 NPI number — DEEPA PADIA DO

Table of content: DEEPA PADIA DO (NPI 1174729560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174729560 NPI number — DEEPA PADIA DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADIA
Provider First Name:
DEEPA
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
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:
1174729560
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1045 CENTRAL PARKWAY NORTH
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78232-5024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-541-4500
Provider Business Mailing Address Fax Number:
210-541-4508

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 BAPTIST HEALTH DR
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
SCHERTZ
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78154-1193
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-566-2656
Provider Business Practice Location Address Fax Number:
210-566-2690
Provider Enumeration Date:
06/22/2007

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: 207Q00000X , with the licence number:  M5868 , 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: 1872616-06 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: M5868 . This is a "TX LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8AE503 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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