NPI |
1871058099 |
The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number. |
Entity Type Code |
2 |
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Employer Identification Number EIN |
|
Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual
human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO). |
Provider Organization Name Legal Business Name |
STILL WATER SPRINGS |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider First Line Business Practice Location Address |
103 EAST AIRLINE ROAD |
The name of the organization provider. If the provider is an organization, this is the legal business name. |
Provider Second Line Business Practice Location Address |
SUITE 3 |
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. |
Provider Business Practice Location Address City Name |
VICTORIA |
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. |
Provider Business Practice Location Address State Name |
TX |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Postal Code |
77901 |
The State code in the location of the provider
being identified. |
Provider Business Practice Location Address Country Code If outside U S |
US |
The country code in the location address of the provider being identified. |
Provider Business Practice Location Address Telephone Number |
3617037103 |
The country code in the location address of the provider being identified. |
Provider Enumeration Date |
2/1/2019 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Last Update Date |
2/1/2019 |
The date the provider was assigned a unique identifier (assigned an NPI). |
Authorized Official Last Name |
MARINTEZ |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official First Name |
AARON |
The last name of the person authorized to submit the NPI application or to change NPS data for a health care provider. |
Authorized Official Middle Name |
J |
The middle name of the authorized official. |
Authorized Official Title or Position |
FAMILY THERAPIST / OWNER |
The middle name of the authorized official. |
Authorized Official Telephone Number |
3617037103 |
The 10-position telephone number of the authorized official. |
Healthcare Provider Taxonomy Code 1 |
101Y00000X |
The 10-position telephone number of the authorized official. |
Healthcare Provider Primary Taxonomy Switch 1 |
Y |
|
Is Organization Subpart |
N |
|
Authorized Official Name Prefix Text |
MR. |
|
Authorized Official Credential Text |
LPC |
|
Healthcare Provider Taxonomy Group 1 |
193400000X SINGLE SPECIALTY GROUP |
|