1992734016 NPI number — SONTERRA ENDOSCOPY CENTER LTD

Table of content: (NPI 1992734016)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992734016 NPI number — SONTERRA ENDOSCOPY CENTER LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SONTERRA ENDOSCOPY CENTER LTD
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:
1992734016
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
225 E SONTERRA BLVD
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78258-3992
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-403-3528
Provider Business Mailing Address Fax Number:
210-481-7622

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
225 E SONTERRA BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78258-3992
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-481-7477
Provider Business Practice Location Address Fax Number:
210-481-7622
Provider Enumeration Date:
07/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GREEN
Authorized Official First Name:
GERALD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
210-403-3528

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , with the licence number:  008069 , 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: 168254401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com