1356372288 NPI number — MISSION PLUS HEALTHCARE LLC

Table of content: (NPI 1356372288)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356372288 NPI number — MISSION PLUS HEALTHCARE LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MISSION PLUS HEALTHCARE LLC
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:
MISSION PLUS HOSPICE
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:
1356372288
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10918 VANCE JACKSON
Provider Second Line Business Mailing Address:
100
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-558-9996
Provider Business Mailing Address Fax Number:
210-558-6397

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10918 VANCE JACKSON
Provider Second Line Business Practice Location Address:
100
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78230
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-558-9996
Provider Business Practice Location Address Fax Number:
210-558-6397
Provider Enumeration Date:
07/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GARCIA
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
VICE PRESIDENT OF BILLING OPERATION
Authorized Official Telephone Number:
210-558-9996

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  008610 , 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: HH2224 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com