1689794554 NPI number — HARVEY J DURBIN JR.

Table of content: (NPI 1689794554)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689794554 NPI number — HARVEY J DURBIN JR.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HARVEY J DURBIN JR.
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:
ABMP CLINIC
Provider Other Organization Name Type Code:
3
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:
1689794554
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79711-0104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-550-9208
Provider Business Mailing Address Fax Number:
432-550-0139

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
855 CENTRAL DR STE 31B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ODESSA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79761-4246
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-550-9208
Provider Business Practice Location Address Fax Number:
432-550-0139
Provider Enumeration Date:
04/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DURBIN
Authorized Official First Name:
HARVEY
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CLINICAL PSYCHOLOGIST
Authorized Official Telephone Number:
432-550-9208

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  21610 , 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: 085831801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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