1134392863 NPI number — BONNY S. OLNEY, D.O., P.A.

Table of content: (NPI 1134392863)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134392863 NPI number — BONNY S. OLNEY, D.O., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BONNY S. OLNEY, D.O., P.A.
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:
BENT TREE WOMEN'S WELLNESS CENTER
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:
1134392863
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18352 DALLAS PKWY
Provider Second Line Business Mailing Address:
#136-458
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75287-5227
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-735-7900
Provider Business Mailing Address Fax Number:
972-735-7902

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18333 PRESTON RD
Provider Second Line Business Practice Location Address:
SUITE #550
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75252-5466
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-735-7900
Provider Business Practice Location Address Fax Number:
972-735-7902
Provider Enumeration Date:
04/02/2008

Additional Information

Authorized Official

Authorized Official Last Name:
OLNEY
Authorized Official First Name:
BONNY
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
972-735-7900

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  J6638 , 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)





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