1841277118 NPI number — 1810 BLDG., LTD.

Table of content: (NPI 1841277118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841277118 NPI number — 1810 BLDG., LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
1810 BLDG., LTD.
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:
MID VALLEY PHYSICAL THERAPY AND REHABILITATION
Provider Other Organization Name Type Code:
3
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:
1841277118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1810 E 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESLACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78596-6648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-968-9392
Provider Business Mailing Address Fax Number:
956-968-5722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1810 E 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESLACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78596-6648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-968-9392
Provider Business Practice Location Address Fax Number:
956-968-5722
Provider Enumeration Date:
12/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HEREDIA
Authorized Official First Name:
ROGER
Authorized Official Middle Name:
R
Authorized Official Title or Position:
GENERAL PARTNER
Authorized Official Telephone Number:
956-968-9392

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , with the licence number:  640450000 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0400X , with the licence number: 553070000 , 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: 157355201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000028EX . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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