1942451075 NPI number — CANCER CARE NETWORK OF SOUTH TEXAS PA

Table of content: (NPI 1942451075)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942451075 NPI number — CANCER CARE NETWORK OF SOUTH TEXAS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CANCER CARE NETWORK OF SOUTH TEXAS PA
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:
1942451075
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7922 EWING HALSELL
Provider Second Line Business Mailing Address:
STE. 220
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-3724
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-614-9548
Provider Business Mailing Address Fax Number:
210-616-0275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7922 EWING HALSELL
Provider Second Line Business Practice Location Address:
STE. 220
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78229-3724
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-614-9548
Provider Business Practice Location Address Fax Number:
210-616-0275
Provider Enumeration Date:
10/07/2008

Additional Information

Authorized Official

Authorized Official Last Name:
GORDON
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-545-6972

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207VX0201X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00U40Q . This is a "BCBS OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 109514302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com