1639692239 NPI number — THE MEDICAL TEAM, INC

Table of content: (NPI 1639692239)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639692239 NPI number — THE MEDICAL TEAM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE MEDICAL TEAM, 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:
1639692239
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 NE LOOP 410 STE 800
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:
78216-5837
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
210-227-9000
Provider Business Mailing Address Fax Number:
210-224-2020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 HAINE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HARLINGEN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78550-8592
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-504-9048
Provider Business Practice Location Address Fax Number:
956-504-9040
Provider Enumeration Date:
07/25/2017

Additional Information

Authorized Official

Authorized Official Last Name:
HARRIS
Authorized Official First Name:
ANGELIQUE
Authorized Official Middle Name:
Authorized Official Title or Position:
CORPORATE ACCOUNTS RECEIVABLE MGR.
Authorized Official Telephone Number:
210-227-9000

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  018357 , 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: 001029999 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 74-1765 . This is a "PALMETTO GBA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 018357 . This is a "TEXAS DEPARTMENT OF HEALTH AND HUMAN SERVICES DEPARTMENT" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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