Organization Active NPI

Guadalupe Valley Neurology and Electrodiagnostics,P a

  • Specialist
  • Seguin, TX
National Provider Identifier
1194816579
Registry record updated Apr 16, 2021
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
J7226 Issued in TX
Legal business name
GUADALUPE VALLEY NEUROLOGY AND ELECTRODIAGNOSTICS,P A
Practice address
634 E Court St
Ste 102
Seguin, TX 78155-5725
Phone
(830) 303-1819
NPI assigned
Sep 28, 2006
Last updated
Apr 16, 2021By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 16, 2021

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

Authorized official

Name
Ms. Virginia Maldonado
Title
Office Manager
Phone
(210) 403-2074

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Specialist 174400000X J7226 TX Primary

Addresses

Primary practice location

634 E Court St
Ste 102
Seguin, TX 78155-5725

Mailing address

115 Gallery Cir Ste 300
San Antonio, TX 78258-3389
Phone (210) 403-2074

Other identifiers 1

IdentifierTypeStateIssuer
099550802MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20090429000076 TX Part B Supplier - Clinic/Group Practice 6800944976 Receives reassigned benefits from 1 practitioner
Practice locations: San Antonio, TX

National Provider Directory

National Provider Directory

Locations

115 Gallery Cir
Ste 300
San Antonio, TX 78258
Phone (210) 654-7246

634 E Court St
Seguin, TX 78155
Phone (210) 303-1819

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1159401600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1618531200000",
    "number": "1194816579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "115 GALLERY CIR STE 300",
            "city": "SAN ANTONIO",
            "state": "TX",
            "postal_code": "782583389",
            "telephone_number": "210-403-2074",
            "fax_number": "210-403-2078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "634 E COURT ST",
            "address_2": "STE 102",
            "city": "SEGUIN",
            "state": "TX",
            "postal_code": "781555725",
            "telephone_number": "830-303-1819"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "GUADALUPE VALLEY NEUROLOGY AND ELECTRODIAGNOSTICS,P A",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-28",
        "last_updated": "2021-04-16",
        "certification_date": "2021-04-16",
        "status": "A",
        "authorized_official_last_name": "MALDONADO",
        "authorized_official_first_name": "VIRGINIA",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "210-403-2074",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "TX",
            "license": "J7226",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "099550802",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Seguin, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.