1962586180 NPI number — MR. JAMES GORDON MINTO JR. MSW

Table of content: MR. JAMES GORDON MINTO JR. MSW (NPI 1962586180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962586180 NPI number — MR. JAMES GORDON MINTO JR. MSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MINTO
Provider First Name:
JAMES
Provider Middle Name:
GORDON
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MSW
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:
1962586180
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/09/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4702 WESLEY ST STE D
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75401-5663
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-455-4114
Provider Business Mailing Address Fax Number:
903-455-2814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
507 DENALI PASS STE 105
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78613-7979
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
844-824-8775
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2006

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: 1041C0700X , with the licence number:  35983 , 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: 0007800054 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 143465603 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00007JB . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 317895 . This is a "PRIVATE HEALTHCARE SYSTEM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 079049 . This is a "VALUE OPTIONS/NORTHSTAR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 146452000 . This is a "MAGELLAN HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1756453 . This is a "FIRST HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 244277 . This is a "COMPSYCH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 203630 . This is a "MHN" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".




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