1144233842 NPI number — DR. ROSANNA D HARDIN DC

Table of content: DR. ROSANNA D HARDIN DC (NPI 1144233842)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144233842 NPI number — DR. ROSANNA D HARDIN DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HARDIN
Provider First Name:
ROSANNA
Provider Middle Name:
D
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

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:
1144233842
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/19/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 962038
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79996-2038
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-594-3099
Provider Business Mailing Address Fax Number:
915-975-8175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2050 TRAWOOD DR
Provider Second Line Business Practice Location Address:
STE 14B
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79935-3513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-594-3099
Provider Business Practice Location Address Fax Number:
915-975-8175
Provider Enumeration Date:
08/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  9108 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 111NN1001X , with the licence number: 9108 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NX0100X , with the licence number: 9108 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 111NX0800X , with the licence number: 9108 , 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: 1680860 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 606391 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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