1063422194 NPI number — CZOP INC

Table of content: (NPI 1063422194)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063422194 NPI number — CZOP INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CZOP 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:
DBA AVADA AUDIOLOGY & HEARING CARE
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:
1063422194
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
844 S. FLEISHEL AVE.
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TYLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75701-2042
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-595-1811
Provider Business Mailing Address Fax Number:
903-595-2809

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
844 S. FLEISHEL AVE.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75701-2042
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-595-1811
Provider Business Practice Location Address Fax Number:
903-595-2809
Provider Enumeration Date:
08/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CZOP
Authorized Official First Name:
CHRISTOPHER
Authorized Official Middle Name:
MARK
Authorized Official Title or Position:
REGIONAL DIRECTOR
Authorized Official Telephone Number:
903-595-1811

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  50630 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237700000X , with the licence number: 50653 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 50636 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237700000X , with the licence number: 50685 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 022136801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0085ME . This is a "BCBS FACILITY NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 516539 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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