1639374374 NPI number — DR. DANIEL GENE CHURCH M.D.

Table of content: DR. DANIEL GENE CHURCH M.D. (NPI 1639374374)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639374374 NPI number — DR. DANIEL GENE CHURCH M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHURCH
Provider First Name:
DANIEL
Provider Middle Name:
GENE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

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:
1639374374
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8401 DATAPOINT DR STE 600
Provider Second Line Business Mailing Address:
P. O. BOX 29441
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-5907
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-616-7796
Provider Business Mailing Address Fax Number:
210-616-7799

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8401 DATAPOINT DR
Provider Second Line Business Practice Location Address:
SUITE 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:
78229-5900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-616-7796
Provider Business Practice Location Address Fax Number:
210-616-7799
Provider Enumeration Date:
06/20/2007

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: 2085R0202X , with the licence number:  M0042 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2085B0100X , with the licence number: M0042 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085D0003X , with the licence number: M0042 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085U0001X , with the licence number: M0042 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0700X , with the licence number: M0042 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085N0904X , with the licence number: M0042 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085P0229X , with the licence number: M0042 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2085R0204X , with the licence number: M0042 , 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: P00736456 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8L14244 . This is a "MEDICARE - STRIC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2027005-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: M0042 . This is a "TEXAS MEDICAL BOARD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2027005-02 . This is a "MEDICAID - CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2027005-03 . This is a "MEDICAID - STRIC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00855904 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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