1750657920 NPI number — ADDICTION MEDICINE CONSULTANTS OF TEXAS, PLLC

Table of content: (NPI 1750657920)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750657920 NPI number — ADDICTION MEDICINE CONSULTANTS OF TEXAS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADDICTION MEDICINE CONSULTANTS OF TEXAS, PLLC
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:
1750657920
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/07/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37131 INTERSTATE 10 W
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
BOERNE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78006-8989
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-577-8666
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
37131 INTERSTATE 10 W
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
BOERNE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78006-8989
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-577-8666
Provider Business Practice Location Address Fax Number:
830-255-4660
Provider Enumeration Date:
03/31/2012

Additional Information

Authorized Official

Authorized Official Last Name:
BUTTS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
512-426-8343

Provider Taxonomy Codes

  • Taxonomy code: 207QA0401X , with the licence number:  H7939 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363L00000X , with the licence number: 672526 , 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: 1023287794 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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