1164432639 NPI number — ERICKSON HEALTH MEDICAL GROUP OF TEXAS PA

Table of content: (NPI 1164432639)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164432639 NPI number — ERICKSON HEALTH MEDICAL GROUP OF TEXAS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ERICKSON HEALTH MEDICAL GROUP OF TEXAS PA
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:
HIGHLAND SPRINGS MEDICAL CENTER
Provider Other Organization Name Type Code:
5
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:
1164432639
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5730 EXECUTIVE DR STE 230
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CATONSVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21228-1762
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-232-8080
Provider Business Mailing Address Fax Number:
972-232-8099

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8000 FRANKFORD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75252-6834
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-232-8080
Provider Business Practice Location Address Fax Number:
972-232-8099
Provider Enumeration Date:
08/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NORMAN
Authorized Official First Name:
MARY
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-402-2257

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207QG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RG0300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LA2200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LG0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SG0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 01-29391 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8BW701 . This is a "BCBS OF TX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 04-60996 . This is a "EVERCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 260341853001 . This is a "TRICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0089EP . This is a "BCBS - FEATHERSTON" identifier . This identifiers is of the category "OTHER".
  • Identifier: 0093NP . This is a "BCBS OF TX" identifier . This identifiers is of the category "OTHER".
  • Identifier: 8AS969 . This is a "BCBS - FEATHERSTON" identifier . This identifiers is of the category "OTHER".




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