Provider Demographics
NPI:1629104849
Name:CARE LEVEL MANAGEMENT MEDICAL GROUP TEXAS, PA
Entity Type:Organization
Organization Name:CARE LEVEL MANAGEMENT MEDICAL GROUP TEXAS, PA
Other - Org Name:CARE LEVEL MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:ST.ANDREW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:800-377-3606
Mailing Address - Street 1:5700 CANOGA AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6579
Mailing Address - Country:US
Mailing Address - Phone:800-377-3606
Mailing Address - Fax:818-595-8206
Practice Address - Street 1:200 CONCORD PLAZA DR
Practice Address - Street 2:SUITE 510
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78216-6943
Practice Address - Country:US
Practice Address - Phone:866-798-2843
Practice Address - Fax:210-798-2851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00669ZMedicare ID - Type UnspecifiedMEDICARE NUMBER