1285926519 NPI number — MRS. CHRYSTIE DENISE TROYER PA

Table of content: MRS. CHRYSTIE DENISE TROYER PA (NPI 1285926519)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285926519 NPI number — MRS. CHRYSTIE DENISE TROYER PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TROYER
Provider First Name:
CHRYSTIE
Provider Middle Name:
DENISE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA
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:
1285926519
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 461629
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78246-1629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-615-7480
Provider Business Mailing Address Fax Number:
210-614-4972

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10007 HUEBNER RD BLDG 2
Provider Second Line Business Practice Location Address:
SUITE #203
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78240-1640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-615-7480
Provider Business Practice Location Address Fax Number:
210-614-4972
Provider Enumeration Date:
05/04/2011

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: 363A00000X , with the licence number:  PA02884 , 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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