1477581601 NPI number — VALVERDE MEDICAL EQUIPMENT

Table of content: (NPI 1477581601)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477581601 NPI number — VALVERDE MEDICAL EQUIPMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VALVERDE MEDICAL EQUIPMENT
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:
1477581601
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:
11385 JAMES WATT DR
Provider Second Line Business Mailing Address:
B-1
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79936-6568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-595-2460
Provider Business Mailing Address Fax Number:
915-595-3229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11385 JAMES WATT DR
Provider Second Line Business Practice Location Address:
B-1
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79936-6568
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-595-2460
Provider Business Practice Location Address Fax Number:
915-595-3229
Provider Enumeration Date:
06/28/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VALVERDE
Authorized Official First Name:
YOLANDA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
915-595-2460

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  0059831 , 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: 19023260 . This is a "NEW MEXICO MEDICAID" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 532090 . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 151806004 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 151806003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0007550366 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".




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