1144261561 NPI number — CARLA J EMERY D.P.M., PA

Table of content: CARLA J EMERY D.P.M., PA (NPI 1144261561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144261561 NPI number — CARLA J EMERY D.P.M., PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EMERY
Provider First Name:
CARLA
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M., PA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CULBERSON
Provider Other First Name:
CARLA
Provider Other Middle Name:
EMERY
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
D.P.M., PA
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1144261561
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/06/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3303 NORTHLAND DR
Provider Second Line Business Mailing Address:
SUITE 308
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78731-4945
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-420-0808
Provider Business Mailing Address Fax Number:
512-420-0969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3303 NORTHLAND DRIVE
Provider Second Line Business Practice Location Address:
SUITE 308
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78731-4956
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-420-0808
Provider Business Practice Location Address Fax Number:
512-420-0969
Provider Enumeration Date:
06/09/2006

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: 213ES0131X , with the licence number:  TX758 , 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)

  • Identifier: 062914001 . This is a "CIGNA GOVT SVCS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00SD10 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 092842601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 181690 . This is a "USA MCO HEALTHNET" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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