1164536777 NPI number — TROM LLC

Table of content: (NPI 1164536777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164536777 NPI number — TROM LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TROM LLC
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:
1164536777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 270015
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLOWER MOUND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75027-0015
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-801-8560
Provider Business Mailing Address Fax Number:
972-459-3062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2680 DENTON TAP RD
Provider Second Line Business Practice Location Address:
SUITE 103
Provider Business Practice Location Address City Name:
LEWISVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75057-8211
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-801-8560
Provider Business Practice Location Address Fax Number:
972-459-3063
Provider Enumeration Date:
08/19/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
RICHARDS
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
214-801-8560

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0091760 . This is a "MEDICAL DEVICE DIST" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".