1184731531 NPI number — RON E. SLATE JR DPM PLLC

Table of content: (NPI 1184731531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184731531 NPI number — RON E. SLATE JR DPM PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RON E. SLATE JR DPM PLLC
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:
1184731531
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2036 E MULBERRY ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANGLETON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77515-3923
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-848-0777
Provider Business Mailing Address Fax Number:
979-849-0757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2036 E MULBERRY ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANGLETON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77515-3923
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-848-0777
Provider Business Practice Location Address Fax Number:
979-849-0757
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SLATE
Authorized Official First Name:
RON
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
MEDICAL DIRECTOR/OWNER
Authorized Official Telephone Number:
979-848-0777

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 171187104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 152063702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 5304710001 . This is a "MEDICARE DME PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8B8071 . This is a "MEDICARE INDIVIDUAL PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00528W . This is a "MEDICARE GROUP PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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