Provider Demographics
NPI:1538101019
Name:ACS PRIMARY CARE PHYSICIANS SOUTHWEST, PA
Entity Type:Organization
Organization Name:ACS PRIMARY CARE PHYSICIANS SOUTHWEST, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER ENROLLMENT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:
Authorized Official - Last Name:HARDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:925-251-6901
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:
Practice Address - Street 1:1900 HOSPITAL BLVD
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76240-2002
Practice Address - Country:US
Practice Address - Phone:925-924-1600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2020-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency MedicineGroup - Multi-Specialty
No208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX170873704Medicaid
TX0019LMOtherBCBS OF TEXAS
TXDC7459OtherMEDICARE RR - PALMETTO
TXDC8546OtherPALMETTO GOVERNMENT BENEF
TX170873701Medicaid
TX0019LMOtherHMO BLUE - TEXAS
TX170873702Medicaid
TX0096MGOtherTEXAS BCBS
TXDC7040OtherPALMETTO GOVERNMENT BENEF
TX170873705Medicaid
TXDD7728OtherMEDICARE RR - PALMETTO
TX0096MGOtherTEXAS BCBS
TX00719XMedicare PIN
TXDD7728OtherMEDICARE RR - PALMETTO
TX00718XMedicare PIN