1134296890 NPI number — PEDIATRIC PULMONARY ASSOC. OF N. TEXAS

Table of content: DR. ROBERT KEN COLEMAN D.C. (NPI 1720132384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134296890 NPI number — PEDIATRIC PULMONARY ASSOC. OF N. TEXAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC PULMONARY ASSOC. OF N. TEXAS
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:
1134296890
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8501 WADE BLVD
Provider Second Line Business Mailing Address:
BLDG X SUITE 1020
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-5894
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-668-5864
Provider Business Mailing Address Fax Number:
972-668-5825

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8501 WADE BLVD
Provider Second Line Business Practice Location Address:
BLDG X SUITE 1020
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-5894
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-566-5864
Provider Business Practice Location Address Fax Number:
972-566-5825
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SILVER
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
B.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-668-5864

Provider Taxonomy Codes

  • Taxonomy code: 2080P0214X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 081278601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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