1497895171 NPI number — MAXMED HEALTHCARE, INC

Table of content: (NPI 1497895171)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497895171 NPI number — MAXMED HEALTHCARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MAXMED HEALTHCARE, INC
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:
1497895171
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 592240
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:
78259-0161
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-599-3233
Provider Business Mailing Address Fax Number:
210-579-6654

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
506 E RAMSEY RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SAN ANTONIO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78216-4657
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
210-599-3233
Provider Business Practice Location Address Fax Number:
210-579-6654
Provider Enumeration Date:
02/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OYEWOLE
Authorized Official First Name:
OLUSEGUN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
210-979-7805

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  008735 , 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: 170427201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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