1033197538 NPI number — MR. SIDNEY CLYDE ENGLAND PA-C

Table of content: MR. SIDNEY CLYDE ENGLAND PA-C (NPI 1033197538)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033197538 NPI number — MR. SIDNEY CLYDE ENGLAND PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ENGLAND
Provider First Name:
SIDNEY
Provider Middle Name:
CLYDE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033197538
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1574
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88202-1574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-627-9110
Provider Business Mailing Address Fax Number:
575-627-4127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
402 W COUNTRY CLUB RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88201-5247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-627-9500
Provider Business Practice Location Address Fax Number:
575-627-9535
Provider Enumeration Date:
01/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  PA01205 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA2013-0094 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Z2565 . This is a "MCD GROUP KYMERA" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: PA2013-0094 . This is a "NM PROVIDER LICENSE" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 800521089 . This is a "MCR GROUP KYMERA" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: 1932187044 . This is a "GROUP NPI" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: PA01205 . This is a "TX LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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