1164825444 NPI number — CT HEALTHCARE GROUP, LLC

Table of content: (NPI 1164825444)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164825444 NPI number — CT HEALTHCARE GROUP, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CT HEALTHCARE GROUP, 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:
EXPERT WOMEN'S IMAGING
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:
1164825444
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7415 LAS COLINAS BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75063-7568
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-379-2700
Provider Business Mailing Address Fax Number:
972-869-3875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
431 EAST STATE HWY.114
Provider Second Line Business Practice Location Address:
SUITE 490
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-379-2700
Provider Business Practice Location Address Fax Number:
972-869-3875
Provider Enumeration Date:
10/01/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ECHT
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
ALLEN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-379-2700

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X , with the licence number:  H6809 , 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)