1801193933 NPI number — EAST SAN ANTONIO IMAGES INC

Table of content: (NPI 1801193933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801193933 NPI number — EAST SAN ANTONIO IMAGES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EAST SAN ANTONIO IMAGES 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:
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:
1801193933
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7201 RR 2222
Provider Second Line Business Mailing Address:
SUITE 2312
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78730-3208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-279-4501
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6300 BRIDGE POINT PKWY
Provider Second Line Business Practice Location Address:
BLDG 3
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78730-5073
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-279-4501
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/25/2011

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
EDMUND
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
512-279-4501

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  H6836 , 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: 0046WK . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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