1215025598 NPI number — MEDCARE ASSOCIATES, P.A.

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 1215025598 NPI number — MEDCARE ASSOCIATES, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDCARE ASSOCIATES, P.A.
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:
1215025598
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2870
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BANDERA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78003-2870
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-796-7713
Provider Business Mailing Address Fax Number:
830-796-7744

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1050 HIGHWAY 16 SOUTH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BANDERA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-796-7713
Provider Business Practice Location Address Fax Number:
830-796-7744
Provider Enumeration Date:
10/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRAZIER
Authorized Official First Name:
RUTH
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE ADMINISTRATOR
Authorized Official Telephone Number:
830-816-5700

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  K0839 , 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: 1215025598 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3347 . This is a "SUPERIOR HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 771 . This is a "COMMUNITY FIRST HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10002909 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2132872 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 191965261126 . This is a "HUMANA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 414865 . This is a "FIRST HEALTH/COVENTRY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0055BY . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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