1245303502 NPI number — HEALTH AND HUMAN SERVICES COMMISSION

Table of content: (NPI 1245303502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245303502 NPI number — HEALTH AND HUMAN SERVICES COMMISSION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTH AND HUMAN SERVICES COMMISSION
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:
RIO GRANDE STATE CENTER
Provider Other Organization Name Type Code:
3
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:
1245303502
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2668
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78551-2668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-425-8900
Provider Business Mailing Address Fax Number:
210-531-8172

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 S RANGERVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78552-7638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-425-8900
Provider Business Practice Location Address Fax Number:
210-531-8172
Provider Enumeration Date:
11/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JANA
Authorized Official Middle Name:
Authorized Official Title or Position:
PROGRAM SUPERVISOR VI
Authorized Official Telephone Number:
512-438-3124

Provider Taxonomy Codes

  • Taxonomy code: 333600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336L0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0845315-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 02312193-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0212193-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0212193-03 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4521642 . This is a "PHARMACY NCPDP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH3020 . This is a "BCBS DRUG ALCOHOL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH4992 . This is a "BCBS PSYCHIATRIC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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