NPIMap

Organization Active NPI

River City Oral and Maxillofacial Surgery, PLLC

  • Oral and Maxillofacial Surgery Clinic/Center
  • San Antonio, TX
National Provider Identifier
1063987626
Registry record updated Oct 10, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Oral and Maxillofacial Surgery Clinic/CenterTaxonomy code 261QS0112X
Legal business name
RIVER CITY ORAL AND MAXILLOFACIAL SURGERY, PLLC
Practice address
5418 N Loop 1604 E
Suite 101
San Antonio, TX 78023
Phone
(210) 778-0002
NPI assigned
Oct 10, 2018
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 10, 2018

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Mark Haverkorn, DDS, MD
Title
Owner
Phone
(210) 778-0002

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Oral and Maxillofacial Surgery Clinic/Center 261QS0112X Primary

Addresses

Primary practice location

5418 N Loop 1604 E
Suite 101
San Antonio, TX 78023

Mailing address

PO Box 1719
Helotes, TX 78023-1719
Phone (210) 778-0002

National Provider Directory

National Provider Directory

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539129600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1539129600000",
    "number": "1063987626",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1719",
            "city": "HELOTES",
            "state": "TX",
            "postal_code": "780231719",
            "telephone_number": "210-778-0002"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5418 N LOOP 1604 E",
            "address_2": "SUITE 101",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "78023",
            "telephone_number": "210-778-0002"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "RIVER CITY ORAL AND MAXILLOFACIAL SURGERY, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-10",
        "last_updated": "2018-10-10",
        "status": "A",
        "authorized_official_last_name": "HAVERKORN",
        "authorized_official_first_name": "MARK",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "210-778-0002",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DDS, MD"
    },
    "taxonomies": [
        {
            "code": "261QS0112X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Oral and Maxillofacial Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Antonio, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.