1457471401 NPI number — SSC PITTSBURG OPERATING COMPANY LP

Table of content: (NPI 1457471401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457471401 NPI number — SSC PITTSBURG OPERATING COMPANY LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SSC PITTSBURG OPERATING COMPANY LP
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:
1457471401
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5300 W SAM HOUSTON PKWY N
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77041-5161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-467-6000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2351 LOVERIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PITTSBURG
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94565-5117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-427-4444
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SANTORO
Authorized Official First Name:
KELLE
Authorized Official Middle Name:
C
Authorized Official Title or Position:
SR DIRECTOR AR
Authorized Official Telephone Number:
832-467-5728

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  140000564 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: LTC55287K . This is a "PREVIOUS MEDICAID NUMBER" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: LTC55287L , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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