1588767198 NPI number — MRS. ALICE PIERCE VIGIL PHD MD

Table of content: MRS. ALICE PIERCE VIGIL PHD MD (NPI 1588767198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588767198 NPI number — MRS. ALICE PIERCE VIGIL PHD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
VIGIL
Provider First Name:
ALICE
Provider Middle Name:
PIERCE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHD MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RICHARDSON
Provider Other First Name:
ALICE
Provider Other Middle Name:
PIERCE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588767198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10204 BIRDLIP CIRCLE
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:
78733
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-402-0927
Provider Business Mailing Address Fax Number:
512-402-1734

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5926 BALCONES DRIVE
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78731
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-459-6976
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  11089 , 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)





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