1356396980 NPI number — NUBY PEDIATRICS PA

Table of content: (NPI 1356396980)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356396980 NPI number — NUBY PEDIATRICS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NUBY PEDIATRICS 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:
Provider Other Organization Name Type Code:
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:
1356396980
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1208 BENT OAKS CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76210-3300
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-566-5437
Provider Business Mailing Address Fax Number:
940-323-0553

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1208 BENT OAKS CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76210-3300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-566-5437
Provider Business Practice Location Address Fax Number:
940-323-0553
Provider Enumeration Date:
05/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DOBBS
Authorized Official First Name:
MARI
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
940-566-5437

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  606596 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 178528602 . This is a "MEDICAID THS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10046727 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0011NJ . This is a "BCBSTX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 178582601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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