1669472577 NPI number — DR. MARCO T SILVA MD

Table of content: DR. MARCO T SILVA MD (NPI 1669472577)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669472577 NPI number — DR. MARCO T SILVA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SILVA
Provider First Name:
MARCO
Provider Middle Name:
T
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1669472577
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 846098
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-6098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-606-6400
Provider Business Mailing Address Fax Number:
903-606-1522

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2965 HARRISON ST
Provider Second Line Business Practice Location Address:
SUITE 111
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77702-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-898-7800
Provider Business Practice Location Address Fax Number:
409-898-3295
Provider Enumeration Date:
07/21/2005

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: 207T00000X , with the licence number:  L7561 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: L7561 , 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: 8813744001 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 148913001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7333499 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0089KH . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: A002 . This is a "TRICARE CHAMPUS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00142069 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0020HD . This is a "GROUP BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1646150 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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