1760574404 NPI number — KILLOUGH ENTERPRISES, INC

Table of content: (NPI 1760574404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760574404 NPI number — KILLOUGH ENTERPRISES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KILLOUGH ENTERPRISES, INC
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:
DANNY R KILLOUGH DC
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:
1760574404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/19/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 N 7TH STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALLINGER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76821
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-365-8888
Provider Business Mailing Address Fax Number:
325-365-2331

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
106 N 7TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALLINGER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76821
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-365-8888
Provider Business Practice Location Address Fax Number:
325-365-2331
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KILLOUGH
Authorized Official First Name:
DANNY
Authorized Official Middle Name:
R
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
325-365-8888

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC8055 , 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: 0047PU . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DD9679 . This is a "RAILROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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