Provider Demographics
NPI:1982665410
Name:ACCORD MEDICAL MANAGEMENT, LP
Entity Type:Organization
Organization Name:ACCORD MEDICAL MANAGEMENT, LP
Other - Org Name:NIX HEALTH CARE SYSTEM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT & CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:LESTER
Authorized Official - Middle Name:S
Authorized Official - Last Name:SURROCK
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:210-271-2190
Mailing Address - Street 1:414 NAVARRO ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78205-2516
Mailing Address - Country:US
Mailing Address - Phone:210-271-2188
Mailing Address - Fax:210-271-2023
Practice Address - Street 1:4402 VANCE JACKSON RD
Practice Address - Street 2:SUITE 140
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-5333
Practice Address - Country:US
Practice Address - Phone:210-271-2188
Practice Address - Fax:210-271-2023
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACCORD MEDICAL MANAGEMENT, LP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-04-02
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX009136251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXHH8387OtherBLUE CROSS HOME CARE
TX2657842OtherAETNA
=========OtherTIN USED BY HEALTH PLANS