1508873696 NPI number — R L TOMS INC

Table of content: (NPI 1508873696)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508873696 NPI number — R L TOMS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
R L TOMS INC
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:
LIVE OAK MEDICAL CENTER
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:
1508873696
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 356
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLANCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78606-0356
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-833-4567
Provider Business Mailing Address Fax Number:
830-833-0466

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
618 LIVE OAK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BLANCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78606-9998
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-833-4567
Provider Business Practice Location Address Fax Number:
830-833-0466
Provider Enumeration Date:
08/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ACHILLES
Authorized Official First Name:
LYNDI
Authorized Official Middle Name:
Authorized Official Title or Position:
REGIONAL ADMINISTRATOR DIRECTOR
Authorized Official Telephone Number:
830-833-4567

Provider Taxonomy Codes

  • Taxonomy code: 313M00000X , with the licence number:  115368 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 313M00000X , with the licence number: 121827 , 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: 000434202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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