Provider Demographics
NPI:1104197193
Name:ACS PRIMARY ADMITTING PROVIDERS, P.A.
Entity Type:Organization
Organization Name:ACS PRIMARY ADMITTING PROVIDERS, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:KRISTOPHER
Authorized Official - Middle Name:M
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-924-1600
Mailing Address - Street 1:5000 HOPYARD RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-3348
Mailing Address - Country:US
Mailing Address - Phone:925-924-1600
Mailing Address - Fax:924-924-0506
Practice Address - Street 1:11800 ASTORIA BLVD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77089-6041
Practice Address - Country:US
Practice Address - Phone:925-924-1600
Practice Address - Fax:924-924-0506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-01-23
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX305959403Medicaid
TX305959401Medicaid
TX305959403Medicaid
TXTXB148543Medicare PIN