1164434411 NPI number — HYDE-CENTER, P.L.L.C.

Table of content: (NPI 1164434411)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164434411 NPI number — HYDE-CENTER, P.L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HYDE-CENTER, P.L.L.C.
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:
6
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:
1164434411
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4220 LITTLE ROAD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-478-2300
Provider Business Mailing Address Fax Number:
817-478-4904

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3101 S. CENTER STREET
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76014
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-466-7057
Provider Business Practice Location Address Fax Number:
817-549-5104
Provider Enumeration Date:
08/13/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HYDE
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-478-2300

Provider Taxonomy Codes

  • Taxonomy code: 1223P0221X , with the licence number:  9223 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1223P0221X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: G60005-1 . This is a "TEXAS CHIP PROGAM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 169951701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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