Provider Demographics
NPI:1053560235
Name:JOHN W KRISTENSEN, M. D.
Entity type:Organization
Organization Name:JOHN W KRISTENSEN, M. D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INSURANCE CLERK
Authorized Official - Prefix:MRS
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAMIREZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:956-689-5506
Mailing Address - Street 1:165 S 6TH ST
Mailing Address - Street 2:
Mailing Address - City:RAYMONDVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78580-3521
Mailing Address - Country:US
Mailing Address - Phone:956-689-5506
Mailing Address - Fax:956-689-1988
Practice Address - Street 1:165 S 6TH ST
Practice Address - Street 2:
Practice Address - City:RAYMONDVILLE
Practice Address - State:TX
Practice Address - Zip Code:78580-3521
Practice Address - Country:US
Practice Address - Phone:956-689-5506
Practice Address - Fax:956-689-1988
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-12
Last Update Date:2008-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXG2414332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00SH91OtherBCBS OF TX
TX121472802Medicaid
TX110005062OtherRAILROAD MEDICARE
TX0299450001Medicare NSC
TX00SH91Medicare UPIN
TX00SH91OtherBCBS OF TX