1689715252 NPI number — PARKHILL PHYSICIAN GROUP, PLLC

Table of content: (NPI 1689715252)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689715252 NPI number — PARKHILL PHYSICIAN GROUP, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKHILL PHYSICIAN GROUP, 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:
AEGIS ANESTHESIA, PLLC
Provider Other Organization Name Type Code:
4
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:
1689715252
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7000 W PLANO PKWY STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75093-8465
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-300-3131
Provider Business Mailing Address Fax Number:
214-723-7582

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7000 W PLANO PKWY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-8465
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-300-3131
Provider Business Practice Location Address Fax Number:
214-723-7582
Provider Enumeration Date:
02/08/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
WYANT
Authorized Official First Name:
GLEN
Authorized Official Middle Name:
RAY
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
469-300-3131

Provider Taxonomy Codes

  • Taxonomy code: 207LP3000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 150096901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".