1184728602 NPI number — RENEE ZIMMERMAN APN-C

Table of content: RENEE ZIMMERMAN APN-C (NPI 1184728602)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184728602 NPI number — RENEE ZIMMERMAN APN-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ZIMMERMAN
Provider First Name:
RENEE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
APN-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GAMBLE
Provider Other First Name:
RENEE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APN-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1184728602
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/26/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 889 119 S. ELLIS
Provider Second Line Business Mailing Address:
FRONTERA HEALTHCARE NETWORK, INC. MENARD CLINIC
Provider Business Mailing Address City Name:
MENARD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76859-0889
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-396-4612
Provider Business Mailing Address Fax Number:
325-396-2055

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
302 N 3RD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALLINGER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76821-5034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-365-5737
Provider Business Practice Location Address Fax Number:
325-365-2405
Provider Enumeration Date:
09/13/2006

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: 363LF0000X , with the licence number:  662078 , 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: 662078 . This is a "APN LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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