1861488579 NPI number — KNAPP MEDICAL CENTER

Table of content: (NPI 1861488579)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861488579 NPI number — KNAPP MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KNAPP MEDICAL CENTER
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:
1861488579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1401 E 8TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WESLACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78596-6640
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
956-968-8567
Provider Business Mailing Address Fax Number:
956-969-1408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1401 E 8TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WESLACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78596-6640
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
956-968-8567
Provider Business Practice Location Address Fax Number:
956-969-1408
Provider Enumeration Date:
09/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SURROCK
Authorized Official First Name:
LESTER
Authorized Official Middle Name:
EDWARD
Authorized Official Title or Position:
CHIEF FINANCIAL OFFICER
Authorized Official Telephone Number:
956-323-9106

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X , with the licence number: 000480 , 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: 104307100 . This is a "VALLEY HEALTH PLANS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: HH0538 . This is a "BC BS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 135035705 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 135035706 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 115440000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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