1700089000 NPI number — CROSSROADS SURGICAL ASSOCIATES, LLP

Table of content: (NPI 1700089000)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700089000 NPI number — CROSSROADS SURGICAL ASSOCIATES, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSSROADS SURGICAL ASSOCIATES, LLP
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:
1700089000
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2705 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 400B
Provider Business Mailing Address City Name:
VICTORIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77901-5775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-574-1556
Provider Business Mailing Address Fax Number:
361-574-1558

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2705 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 400B
Provider Business Practice Location Address City Name:
VICTORIA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77901-5775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-574-1556
Provider Business Practice Location Address Fax Number:
361-574-1558
Provider Enumeration Date:
06/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
VELA-CISNEROS
Authorized Official First Name:
SANDRA
Authorized Official Middle Name:
R
Authorized Official Title or Position:
OFFICE MANGER
Authorized Official Telephone Number:
361-574-1556

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 080825501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0059CZ . This is a "BLUE CROSS/SHIELD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com