1710920160 NPI number — DR. JOHN THACHIL MD

Table of content: DR. JOHN THACHIL MD (NPI 1710920160)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710920160 NPI number — DR. JOHN THACHIL MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THACHIL
Provider First Name:
JOHN
Provider Middle Name:
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:
1710920160
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 911230
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:
75391-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-997-8000
Provider Business Mailing Address Fax Number:
972-234-2987

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13300 HARGRAVE RD
Provider Second Line Business Practice Location Address:
STE 190
Provider Business Practice Location Address City Name:
HOUSTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77070-4379
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-332-7505
Provider Business Practice Location Address Fax Number:
281-897-1215
Provider Enumeration Date:
06/14/2006

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: 207RH0003X , with the licence number:  K4588 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RX0202X , with the licence number: K4588 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 129003305 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129003307 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8R1567 . This is a "BLUE CROSS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 129003302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100064000A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 129003306 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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