1043454531 NPI number — NORTH TEXAS ENT BRENT METTS MD PA

Table of content: (NPI 1043454531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043454531 NPI number — NORTH TEXAS ENT BRENT METTS MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH TEXAS ENT BRENT METTS 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:
SAMUEL O ANTONY JR. MD PA
Provider Other Organization Name Type Code:
4
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:
1043454531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7801 LAKEVIEW PKWY
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
ROWLETT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75088-4247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-475-9151
Provider Business Mailing Address Fax Number:
972-475-1757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7801 LAKEVIEW PKWY
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
ROWLETT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75088-4247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-475-9151
Provider Business Practice Location Address Fax Number:
972-475-1757
Provider Enumeration Date:
04/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
METTS
Authorized Official First Name:
BRENT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
972-475-9151

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0032765201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com