1205089406 NPI number — PEDIATRIC ANESTHESIA CONSULTANTS OF SAN ANTONIO PLLC

Table of content: (NPI 1205089406)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205089406 NPI number — PEDIATRIC ANESTHESIA CONSULTANTS OF SAN ANTONIO PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC ANESTHESIA CONSULTANTS OF SAN ANTONIO PLLC
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:
1205089406
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/21/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7711 LOUIS PASTEUR DR
Provider Second Line Business Mailing Address:
STE 708
Provider Business Mailing Address City Name:
SAN ANTONIO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78229-3415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-575-7828
Provider Business Mailing Address Fax Number:
866-741-3697

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7700 FLOYD CURL DR
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:
78229-3902
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-575-7827
Provider Business Practice Location Address Fax Number:
866-741-3697
Provider Enumeration Date:
10/31/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
CLOUD
Authorized Official First Name:
ROBERTA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
VICE PRESIDENT OF MANAGING MEMBER
Authorized Official Telephone Number:
210-575-7827

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP3000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 19779104 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 197749801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 197749803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".