1679504856 NPI number — MRS. ANNE WARREN ENGEL HOLDORF PA-C

Table of content: MRS. ANNE WARREN ENGEL HOLDORF PA-C (NPI 1679504856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679504856 NPI number — MRS. ANNE WARREN ENGEL HOLDORF PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOLDORF
Provider First Name:
ANNE
Provider Middle Name:
WARREN ENGEL
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1679504856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/21/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 780
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORANGE GROVE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78372-0780
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-384-3341
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2510 E. MAIN, SUITE 102
Provider Second Line Business Practice Location Address:
ALICE INTERNAL MEDICINE CONSULTANTS, PA
Provider Business Practice Location Address City Name:
ALICE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78332
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-664-4445
Provider Business Practice Location Address Fax Number:
361-664-4449
Provider Enumeration Date:
07/05/2006

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: 363A00000X , with the licence number:  PA 00157 , 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: PA 00157 . This is a "STATE LICENSE #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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