Basic Information
| Provider Information | |||||||||
| NPI: | 1114206588 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | I.V. CARE OF S.A, INC. | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | NETCARE DME | ||||||||
| OtherOrganizationType: | 3 | ||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 6428 BANDERA RD | ||||||||
| Address2: | |||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782381511 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2102568629 | ||||||||
| FaxNumber: | 2102568199 | ||||||||
| Practice Location | |||||||||
| Address1: | 810 SE MILITARY DR | ||||||||
| Address2: | SUITE A | ||||||||
| City: | SAN ANTONIO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 782142823 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2109234493 | ||||||||
| FaxNumber: | 2109234166 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/16/2011 | ||||||||
| LastUpdateDate: | 08/16/2011 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BUCHMEIER | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
| AuthorizedOfficialMiddleName: | ALLEN | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PHARMACIST IN CHARGE | ||||||||
| AuthorizedOfficialTelephone: | 2104904320 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | PHARMACIST | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 333600000X | 18620 | TX | N | Suppliers | Pharmacy | 251E00000X | 18620 | TX | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 167964901 | 01 | TX | TPI# | OTHER | 144664 | 05 | TX | MEDICAID | 167964902 | 01 | TX | TPI# | OTHER |