1205821345 NPI number — SOUTH TEXAS HEALTH CARE SYSTEM

Table of content: (NPI 1205821345)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205821345 NPI number — SOUTH TEXAS HEALTH CARE SYSTEM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTH TEXAS HEALTH CARE SYSTEM
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:
SOUTH TEXAS HOSPITAL
Provider Other Organization Name Type Code:
4
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:
1205821345
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 S RANGERVILLE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARLINGEN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78552-7638
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-364-8741
Provider Business Mailing Address Fax Number:
956-425-2692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 S RANGERVILLE RD
Provider Second Line Business Practice Location Address:
OPC PHARMACY - BLDG 504
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78552-7638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-364-8741
Provider Business Practice Location Address Fax Number:
956-425-2692
Provider Enumeration Date:
09/14/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HERNANDEZ-KEEBLE
Authorized Official First Name:
SONIA
Authorized Official Middle Name:
Authorized Official Title or Position:
SUPERINTENDENT
Authorized Official Telephone Number:
956-364-8401

Provider Taxonomy Codes

  • Taxonomy code: 333600000X , with the licence number:  019599 , 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: 800000 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com