1477518611 NPI number — NEJEMIE ALTER, M.D., P.A.

Table of content: (NPI 1477518611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477518611 NPI number — NEJEMIE ALTER, M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEJEMIE ALTER, M.D., P.A.
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:
1477518611
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/03/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 61034
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78466-1034
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-814-8055
Provider Business Mailing Address Fax Number:
361-814-8066

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 3RD ST
Provider Second Line Business Practice Location Address:
SUITE 7
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78404-2356
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-814-8055
Provider Business Practice Location Address Fax Number:
361-814-8066
Provider Enumeration Date:
04/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALTER
Authorized Official First Name:
NEJEMIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
361-814-8055

Provider Taxonomy Codes

  • Taxonomy code: 2080P0207X , with the licence number:  K1771 , 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: 176795601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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