1952380511 NPI number — SAN ANTONIO SURGICAL ARTS, P.A.

Table of content: (NPI 1083884803)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952380511 NPI number — SAN ANTONIO SURGICAL ARTS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SAN ANTONIO SURGICAL ARTS, P.A.
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:
1952380511
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6501 BLANCO RD
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:
78216-6627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-341-7264
Provider Business Mailing Address Fax Number:
210-308-1077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6501 BLANCO RD
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:
78216-6627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-341-7264
Provider Business Practice Location Address Fax Number:
210-341-2022
Provider Enumeration Date:
01/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CASILLAS
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
210-341-7264

Provider Taxonomy Codes

  • Taxonomy code: 1223S0112X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223S0112X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009624008 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 023065801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009624001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00N96A . This is a "BCBS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 009624002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009624003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009624005 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009624006 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 009624007 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 838355 . This is a "UNITED CONCORDIA" identifier . This identifiers is of the category "OTHER".
  • Identifier: CE7550 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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