1609092188 NPI number — ANCHOR CLANKER INC

Table of content: (NPI 1609092188)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609092188 NPI number — ANCHOR CLANKER INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANCHOR CLANKER 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:
1609092188
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1267
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INGLESIDE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78362-1267
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-238-4083
Provider Business Mailing Address Fax Number:
214-233-0329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2051 W WHEELER AVE
Provider Second Line Business Practice Location Address:
STE #5
Provider Business Practice Location Address City Name:
ARANSAS PASS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78336-4762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-523-8241
Provider Business Practice Location Address Fax Number:
888-201-8760
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
JONES
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
M
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
361-523-8241

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: S09573 , 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: 0002QA . This is a "BLUE CROSS BLUE SHIELD TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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