1881639615 NPI number — ACD-SA, LTD.

Table of content: (NPI 1881639615)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881639615 NPI number — ACD-SA, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ACD-SA, 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:
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:
1881639615
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 301749
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78703-0030
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-454-9597
Provider Business Mailing Address Fax Number:
512-458-6770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7220 LOUIS PASTEUR DR
Provider Second Line Business Practice Location Address:
115
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-4537
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-8899
Provider Business Practice Location Address Fax Number:
512-458-6770
Provider Enumeration Date:
06/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MARTIN
Authorized Official First Name:
TARA
Authorized Official Middle Name:
J
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
512-454-9598

Provider Taxonomy Codes

  • Taxonomy code: 261QP3300X , with the licence number:  000393 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR0200X , 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: 470000396 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 109373404 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109373402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 490004721 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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