1508960238 NPI number — DR. TIMOTHY ORLANDO TESI DPM

Table of content: DR. TIMOTHY ORLANDO TESI DPM (NPI 1508960238)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508960238 NPI number — DR. TIMOTHY ORLANDO TESI DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TESI
Provider First Name:
TIMOTHY
Provider Middle Name:
ORLANDO
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

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:
1508960238
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/06/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
270 E HUNT HWY STE 16 BOX 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SAN TAN VALLEY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85143
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-756-5540
Provider Business Mailing Address Fax Number:
903-756-5748

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 N VALE ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JEFFERSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75657-2256
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-665-3339
Provider Business Practice Location Address Fax Number:
903-756-5748
Provider Enumeration Date:
09/12/2006

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: 213EP1101X , with the licence number:  1154 , 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: 092782402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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