1346577996 NPI number — MISTI M MAYS NP

Table of content: MISTI M MAYS NP (NPI 1346577996)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346577996 NPI number — MISTI M MAYS NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MAYS
Provider First Name:
MISTI
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COX
Provider Other First Name:
MISTI
Provider Other Middle Name:
M
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1346577996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 451 ABILENE STATE SUPPORTED LIVING CENTER
Provider Second Line Business Mailing Address:
MAIL CODE 6003
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79604-0451
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-692-4053
Provider Business Mailing Address Fax Number:
325-795-3037

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
ABILENE STATE SUPPORTED LIVING CENTER
Provider Second Line Business Practice Location Address:
2501 MAPLE STREET
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79602-5058
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-692-4053
Provider Business Practice Location Address Fax Number:
325-795-3037
Provider Enumeration Date:
11/03/2009

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: 363LF0000X , with the licence number:  707066 , 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: 208278601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208278602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 208278603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".