1447201579 NPI number — VERICARE OF TEXAS, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447201579 NPI number — VERICARE OF TEXAS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERICARE OF TEXAS, P.A.
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:
VERICARE
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:
1447201579
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
04/11/2007
NPI Reactivation Date:
08/08/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 HATCHETTS HILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLD LYME
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06371-1534
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
800-370-3651
Provider Business Mailing Address Fax Number:
877-515-7147

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 N. MCKINNEY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SWEENY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77480-3400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-257-8715
Provider Business Practice Location Address Fax Number:
800-819-1655
Provider Enumeration Date:
05/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KING
Authorized Official First Name:
MELISSA
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR, CREDENTIALING ENROLLMENT
Authorized Official Telephone Number:
800-370-3651

Provider Taxonomy Codes

  • Taxonomy code: 2084P0805X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0808X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 364SP0813X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1300824-08 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: CG8005 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com