1578635892 NPI number — TEXAS HILL COUNTRY ANESTHESIA PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578635892 NPI number — TEXAS HILL COUNTRY ANESTHESIA PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS HILL COUNTRY ANESTHESIA PA
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:
1578635892
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/14/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 141456
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78714
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-225-6345
Provider Business Mailing Address Fax Number:
512-692-5205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7900 FM 1826
Provider Second Line Business Practice Location Address:
SETON SOUTHWEST
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-324-9808
Provider Business Practice Location Address Fax Number:
512-324-9086
Provider Enumeration Date:
11/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CHAMPAGNE-MILLER
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
R
Authorized Official Title or Position:
ADMIN ASST
Authorized Official Telephone Number:
512-225-6345

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X , with the licence number:  24332 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207L00000X , with the licence number: L1048 , 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)

  • Identifier: 0038HD . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 157276001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com