1053352310 NPI number — TEXAS FAMILY AND OCCUPATIONAL HEALTH SERVICES I, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053352310 NPI number — TEXAS FAMILY AND OCCUPATIONAL HEALTH SERVICES I, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS FAMILY AND OCCUPATIONAL HEALTH SERVICES I, 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:
STAR MEDICAL GROUP
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:
1053352310
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/22/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
POB 810478
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75381-0478
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-572-8835
Provider Business Mailing Address Fax Number:
972-759-1518

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2300 VALLEY VIEW LN
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FARMERS BRANCH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75234-5753
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-572-8835
Provider Business Practice Location Address Fax Number:
972-759-1518
Provider Enumeration Date:
06/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VITT
Authorized Official First Name:
JEFF
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-572-8835

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1780942 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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