1760621692 NPI number — SETON/UT SOUTHWESTERN UNIVERSITY PHYSICIANS GROUP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760621692 NPI number — SETON/UT SOUTHWESTERN UNIVERSITY PHYSICIANS GROUP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SETON/UT SOUTHWESTERN UNIVERSITY PHYSICIANS GROUP
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:
1760621692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 RIO GRANDE
Provider Second Line Business Mailing Address:
SUITE 415
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78701
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-324-8960
Provider Business Mailing Address Fax Number:
512-324-8962

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1601 RIO GRANDE ST
Provider Second Line Business Practice Location Address:
SUITE 340
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78701-1137
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-324-8960
Provider Business Practice Location Address Fax Number:
512-324-8962
Provider Enumeration Date:
02/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
HARVEY
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
512-324-8617

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: OA3612 . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 211346601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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