Provider Demographics
NPI:1053366112
Name:P J R GROUP INC
Entity type:Organization
Organization Name:P J R GROUP INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:I.S.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:F
Authorized Official - Last Name:WILLIS
Authorized Official - Suffix:
Authorized Official - Credentials:BSBA
Authorized Official - Phone:210-377-2559
Mailing Address - Street 1:5368 FREDRICKSBURG RD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78229
Mailing Address - Country:US
Mailing Address - Phone:210-377-2559
Mailing Address - Fax:210-525-1842
Practice Address - Street 1:500 NORTH SHORELINE DR
Practice Address - Street 2:SUITE 1120
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78471
Practice Address - Country:US
Practice Address - Phone:361-887-4850
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-24
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX457247Medicare Oscar/Certification
TX1053366112Medicare Oscar/Certification