1215012570 NPI number — TEXAS HEMATOLOGY/ONCOLOGY CENTER, PA

Table of content: (NPI 1215012570)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215012570 NPI number — TEXAS HEMATOLOGY/ONCOLOGY CENTER, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS HEMATOLOGY/ONCOLOGY CENTER, 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:
TX HEMATOLOGY/ONCOLOGY CENTER-CARROLLTON PHARMACY
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:
1215012570
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10 MEDICAL PKWY
Provider Second Line Business Mailing Address:
SUITE#106
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75234-7840
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-247-5510
Provider Business Mailing Address Fax Number:
972-243-9178

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4352 NORTH JOSEY LANE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARROLLTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-395-1010
Provider Business Practice Location Address Fax Number:
972-394-5780
Provider Enumeration Date:
10/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BIRENBAUM
Authorized Official First Name:
DENNIS
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT/OWNER
Authorized Official Telephone Number:
972-247-5510

Provider Taxonomy Codes

  • Taxonomy code: 3336C0003X , with the licence number:  24457 , 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: 24457 . This is a "PHARMACY LICENSE#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 4541618 . This is a "NCPDP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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