NPI |
1225208200 |
The second line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot
include a Post Office box. |
Entity Type Code |
2 |
The city name in the location address of the provider being identified. |
Employer Identification Number EIN |
|
The State code in the location of the provider
being identified. |
Provider Organization Name Legal Business Name |
GERIATRIC EVALUATION & MENTAL |
The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. |
Provider First Line Business Practice Location Address |
4501 DUDMAR DR |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address City Name |
AUSTIN |
The city name in the location address of the provider being identified. |
Provider Business Practice Location Address State Name |
TX |
The date the provider was assigned a unique identifier (assigned an NPI). |
Provider Business Practice Location Address Postal Code |
787356913 |
The date that a record was last updated or changed. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Provider Business Practice Location Address Telephone Number |
8324482800 |
The first name of the authorized official. |
Provider Business Practice Location Address Fax Number |
8324482801 |
The fax number associated with the location
address of the provider being identified. |
Provider Enumeration Date |
3/6/2008 |
The title or position of the authorized official. |
Last Update Date |
3/17/2008 |
The date that a record was last updated or changed. |
Authorized Official Last Name |
GERSTENHABER |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Authorized Official First Name |
GARY |
|
Authorized Official Title or Position |
MANAGER |
|
Authorized Official Telephone Number |
5123017200 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
103TC0700X |
Code designating the provider type, classification,
and specialization. Codes are from the Healthcare Provider Taxonomy code list. The NPS will associate these data with the license data for providers with Entity type code = 1. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Other Provider Identifier 1 |
CJ2516 |
Additional number currently or formerly used as an identifier for the provider being identified. This data element will be captured from the NPI application/update form. |
Other Provider Identifier Type Code 1 |
01 |
Code indicating the type of identifier currently
or formerly used by the provider being identified. The codes may reflect UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers. This data element will be captured from the NPI application/update form. |
Other Provider Identifier State 1 |
TX |
|
Other Provider Identifier Issuer 1 |
RAILROAD MEDICARE |
|
Is Organization Subpart |
N |
|
Healthcare Provider Taxonomy Group 1 |
193200000X MULTI-SPECIALTY GROUP |
|