1093868556 NPI number — SPUR MEDICAL CORPORATION

Table of content: (NPI 1093868556)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093868556 NPI number — SPUR MEDICAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPUR MEDICAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
SPUR CLINIC
Provider Other Organization Name Type Code:
3
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:
1093868556
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
907 E. HILL ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPUR
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79370-2532
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-271-3306
Provider Business Mailing Address Fax Number:
806-271-4256

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
907 E HILL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPUR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79370-2532
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-271-3306
Provider Business Practice Location Address Fax Number:
806-271-4256
Provider Enumeration Date:
01/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WHITE
Authorized Official First Name:
GLENDA
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
806-271-3306

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  F3709 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 063674801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 079808401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100106106 . This is a "FIRSTCARE PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1275617177 . This is a "STEVE B. ALLEY, M.D. NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1285787762 . This is a "JENNIFER WARREN, NPI#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 137930707 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0636748-02 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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