1487658050 NPI number — RGV-NUECES REHABILITATION, INC.

Table of content: (NPI 1487658050)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487658050 NPI number — RGV-NUECES REHABILITATION, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RGV-NUECES REHABILITATION, INC.
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:
1487658050
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1329
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HELOTES
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78023-1329
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-921-2111
Provider Business Mailing Address Fax Number:
210-921-2444

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
102 PALO ALTO RD
Provider Second Line Business Practice Location Address:
SUITE 465
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78211-3758
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-921-2111
Provider Business Practice Location Address Fax Number:
210-921-2444
Provider Enumeration Date:
06/10/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHANEN
Authorized Official First Name:
PETER
Authorized Official Middle Name:
JOHN
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
210-921-2111

Provider Taxonomy Codes

  • Taxonomy code: 225100000X , with the licence number:  629340000 , 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: I070440 . This is a "INTERPLAN HEALTH PLAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 6400150 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10066488 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7712156 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0079DL . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 080735601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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