1437308509 NPI number — SAN ANTONIO PAIN CONSULTANTS PA

Table of content: (NPI 1437308509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437308509 NPI number — SAN ANTONIO PAIN CONSULTANTS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN ANTONIO PAIN CONSULTANTS PA
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:
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:
1437308509
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 592239
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:
78259-0161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-963-5100
Provider Business Mailing Address Fax Number:
210-963-7032

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3903 WISEMAN BLVD STE 117
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78251-4402
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-861-5461
Provider Business Practice Location Address Fax Number:
210-773-1808
Provider Enumeration Date:
09/15/2008

Additional Information

Authorized Official

Authorized Official Last Name:
ZAGUNIS
Authorized Official First Name:
DARIUS
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
210-268-8270

Provider Taxonomy Codes

  • Taxonomy code: 173000000X , with the licence number:  M3802 , 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)





Copyright © 2007-2025 www.npivalidator.com