1194763383 NPI number — TEXAS PREMIER INTERNAL MEDICINE

Table of content: (NPI 1194763383)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194763383 NPI number — TEXAS PREMIER INTERNAL MEDICINE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXAS PREMIER INTERNAL MEDICINE
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:
ARLINGTON INPATIENT PHYSICIANS, P.A.
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:
1194763383
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
909A MEDICAL CENTRE DR
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:
76012-4757
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-274-5580
Provider Business Mailing Address Fax Number:
817-274-5540

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
909A MEDICAL CENTRE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76012-4757
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-274-5580
Provider Business Practice Location Address Fax Number:
817-274-5540
Provider Enumeration Date:
06/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FORDJOUR
Authorized Official First Name:
KUSI
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN OWNER
Authorized Official Telephone Number:
817-274-5580

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0082MW . This is a "BLUE CROSS BLUE SHEILD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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