1295390581 NPI number — INTERVENTIONAL PARTNERS PLLC

Table of content: (NPI 1295390581)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295390581 NPI number — INTERVENTIONAL PARTNERS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERVENTIONAL PARTNERS PLLC
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:
WYLIE FOOT & ANKLE SPECIALISTS
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:
1295390581
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8135 FOREST LN # 515057
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75230-2472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-850-5760
Provider Business Mailing Address Fax Number:
469-716-4193

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 W FM 544 STE 230
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYLIE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75098-4973
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-288-9034
Provider Business Practice Location Address Fax Number:
972-289-8025
Provider Enumeration Date:
05/02/2019

Additional Information

Authorized Official

Authorized Official Last Name:
STEIN
Authorized Official First Name:
JARYD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, CHIEF EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
469-850-5760

Provider Taxonomy Codes

  • Taxonomy code: 213ES0103X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7736730013 . This is a "NSC DME SUPPLIER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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