1861782161 NPI number — PATRICIA H. LUCE MD PA

Table of content: (NPI 1861782161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861782161 NPI number — PATRICIA H. LUCE MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICIA H. LUCE MD PA
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:
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:
1861782161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/02/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4002 S LOOP 256
Provider Second Line Business Mailing Address:
SUITE S
Provider Business Mailing Address City Name:
PALESTINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75801-8491
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-729-2428
Provider Business Mailing Address Fax Number:
903-723-2892

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4002 S LOOP 256
Provider Second Line Business Practice Location Address:
SUITE S
Provider Business Practice Location Address City Name:
PALESTINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75801-8491
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-729-2428
Provider Business Practice Location Address Fax Number:
903-723-2892
Provider Enumeration Date:
04/08/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LUCE
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
HARPER
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
903-641-1164

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  J8036 , 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: 130591707 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1304917-09 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1304917-08 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: F97841 . This is a "UPIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com