1497105969 NPI number — CENTERPOINT ORIENTAL MEDICINE, PLLC

Table of content: (NPI 1497105969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497105969 NPI number — CENTERPOINT ORIENTAL MEDICINE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTERPOINT ORIENTAL MEDICINE, PLLC
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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497105969
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12315 JONES MALTSBERGER RD
Provider Second Line Business Mailing Address:
#406
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78247-4281
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-653-5194
Provider Business Mailing Address Fax Number:
210-855-0462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12915 JONES MALTSBERGER RD
Provider Second Line Business Practice Location Address:
BUILDING #600
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78247-4282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-653-5194
Provider Business Practice Location Address Fax Number:
210-855-0462
Provider Enumeration Date:
06/15/2016

Additional Information

Authorized Official

Authorized Official Last Name:
SPELL
Authorized Official First Name:
CHRISTANNE
Authorized Official Middle Name:
Authorized Official Title or Position:
FOUNDING MEMBER/ACUPUNCTURIST
Authorized Official Telephone Number:
512-653-5194

Provider Taxonomy Codes

  • Taxonomy code: 171100000X , with the licence number:  AC01681 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 171100000X , with the licence number: AC01619 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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