1891177804 NPI number — FERTILITY INSTITUTE OF TEXAS, PLLC

Table of content: (NPI 1144501495)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891177804 NPI number — FERTILITY INSTITUTE OF TEXAS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FERTILITY INSTITUTE 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:
1891177804
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
540 OAK CENTRE DR STE 260
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-4767
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-277-8111
Provider Business Mailing Address Fax Number:
830-620-9077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
540 OAK CENTRE DR STE 260
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-4767
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-277-8111
Provider Business Practice Location Address Fax Number:
830-620-9077
Provider Enumeration Date:
06/25/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
HUDSON
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
830-660-8442

Provider Taxonomy Codes

  • Taxonomy code: 207VE0102X , with the licence number:  L9256 , 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: 1194927285 . This is a "NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1649289927 . This is a "NPI" identifier . This identifiers is of the category "OTHER".