1891746087 NPI number — KARSEN DIAGNOSTICS LLC

Table of content: (NPI 1891746087)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891746087 NPI number — KARSEN DIAGNOSTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KARSEN DIAGNOSTICS LLC
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:
AYLWIN K PARKER
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:
1891746087
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1954 E HOUSTON ST
Provider Second Line Business Mailing Address:
SUITE 106
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78202-2951
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-270-0331
Provider Business Mailing Address Fax Number:
210-587-2491

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1954 E HOUSTON ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78202-2951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-270-0331
Provider Business Practice Location Address Fax Number:
210-587-2491
Provider Enumeration Date:
05/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
AYLWIN
Authorized Official Middle Name:
KARSEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
210-270-0331

Provider Taxonomy Codes

  • Taxonomy code: 246XS1301X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 246ZE0600X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 178384701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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