1023010386 NPI number — ARLINGTON PREMIER HEALTH CLINIC PA

Table of content: (NPI 1023010386)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023010386 NPI number — ARLINGTON PREMIER HEALTH CLINIC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARLINGTON PREMIER HEALTH CLINIC 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:
1023010386
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
501 RITA LN
Provider Second Line Business Mailing Address:
STE 109
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76014-2010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-465-4141
Provider Business Mailing Address Fax Number:
817-465-9714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
501 RITA LN
Provider Second Line Business Practice Location Address:
STE 109
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76014-2010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-465-4141
Provider Business Practice Location Address Fax Number:
817-465-9714
Provider Enumeration Date:
06/01/2005

Additional Information

Authorized Official

Authorized Official Last Name:
ALANIZ
Authorized Official First Name:
LIZ
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
817-465-4141

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  J7772 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: K5368 , 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: 110176762 . This is a "RR MEDICARE T DAO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5787151 . This is a "CIGNA PROV T DAO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 84540S . This is a "BCBS PROV NUMBER T DAO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1848499 . This is a "UHC PROVIDER # T DAO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 91145876 . This is a "WAUSAU PROV # T DAO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: J7772 . This is a "UNICARE DR MICHAEL V DAO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2079885 . This is a "AETNA PROVIDER #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 132930100 . This is a "NPPN2 DR MICHAEL V DAO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0059554 . This is a "PACIFICARE PPO T DAO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 84541S . This is a "BCBS PROV # M DAO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5907540 . This is a "CIGNA DR MICHAEL V DAO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 91145876 . This is a "WAUSAU DR MICHAEL V DAO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: K5368 . This is a "UNICARE PROV # T DAO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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