1235248394 NPI number — NEW ALLIANCE OF INDEPENDENT

Table of content: (NPI 1235248394)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235248394 NPI number — NEW ALLIANCE OF INDEPENDENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEW ALLIANCE OF INDEPENDENT
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:
1235248394
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3267 BEE CAVE ROAD, 107-190
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78746-6700
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-345-2771
Provider Business Mailing Address Fax Number:
512-345-6517

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3267 BEE CAVE RD # 107-190
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78746-6700
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-345-2771
Provider Business Practice Location Address Fax Number:
512-345-6517
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BEAVER
Authorized Official First Name:
JAN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF OPERATIONS
Authorized Official Telephone Number:
512-345-2771

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0041318 , 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: 530714 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 139682716 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 22985 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 171934601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7965083 . This is a "AETNA PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1430439 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200234860 , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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