Basic Information
| Provider Information | |||||||||
| NPI: | 1538101019 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ACS PRIMARY CARE PHYSICIANS SOUTHWEST, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5000 HOPYARD RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | PLEASANTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945883348 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259241600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1900 HOSPITAL BLVD | ||||||||
| Address2: | |||||||||
| City: | GAINESVILLE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 762402002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9259241600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/11/2006 | ||||||||
| LastUpdateDate: | 02/20/2020 | ||||||||
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| AuthorizedOfficialLastName: | HARDY | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
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| AuthorizedOfficialTitleorPosition: | PROVIDER ENROLLMENT DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 9252516901 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 02/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0204X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Emergency Medicine | 208M00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Hospitalist | 207Q00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine | 207R00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | 363A00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LF0000X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LP0200X | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 207P00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Emergency Medicine |
ID Information
| ID | Type | State | Issuer | Description | 170873704 | 05 | TX | MEDICAID | 0019LM | 01 | TX | BCBS OF TEXAS | OTHER | DC7459 | 01 | TX | MEDICARE RR - PALMETTO | OTHER | DC8546 | 01 | TX | PALMETTO GOVERNMENT BENEF | OTHER | 170873701 | 05 | TX | MEDICAID | 0019LM | 01 | TX | HMO BLUE - TEXAS | OTHER | 170873702 | 05 | TX | MEDICAID | 0096MG | 01 | TX | TEXAS BCBS | OTHER | DC7040 | 01 | TX | PALMETTO GOVERNMENT BENEF | OTHER | 170873705 | 05 | TX | MEDICAID | DD7728 | 01 | TX | MEDICARE RR - PALMETTO | OTHER |