1619151297 NPI number — GP HEALTH CLINIC, PLLC

Table of content: (NPI 1619151297)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619151297 NPI number — GP HEALTH CLINIC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GP HEALTH CLINIC, PLLC
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:
1619151297
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/08/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 168362
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75016-8362
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-939-7120
Provider Business Mailing Address Fax Number:
682-270-8727

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
912 WRIGHT ST
Provider Second Line Business Practice Location Address:
STE D
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76012
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-864-8855
Provider Business Practice Location Address Fax Number:
682-270-8727
Provider Enumeration Date:
12/19/2007

Additional Information

Authorized Official

Authorized Official Last Name:
GAO
Authorized Official First Name:
WEI
Authorized Official Middle Name:
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
469-939-7120

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  L0191 , 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: 1O3160 . This is a "MEDICARE PTAN" identifier . This identifiers is of the category "OTHER".




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