1962602763 NPI number — METRO NORTH CARDIOVASCULAR ASSOCIATES, P.A

Table of content: HAROLD BUSCH JR. MA, PLPC (NPI 1639605405)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962602763 NPI number — METRO NORTH CARDIOVASCULAR ASSOCIATES, P.A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
METRO NORTH CARDIOVASCULAR ASSOCIATES, 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:
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:
1962602763
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1003 NE LOOP 410
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:
78209-1205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-654-6000
Provider Business Mailing Address Fax Number:
210-654-6014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1003 NE LOOP 410
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:
78209-1205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-654-6000
Provider Business Practice Location Address Fax Number:
210-654-6014
Provider Enumeration Date:
07/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GAROUTTE
Authorized Official First Name:
PEGGY
Authorized Official Middle Name:
SUE
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
210-654-6000

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  H9639 , 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: 085790602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 83Z820 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: CC8198 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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