1205540408 NPI number — CARRUS CARE PHYSICIANS GROUP INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205540408 NPI number — CARRUS CARE PHYSICIANS GROUP INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARRUS CARE PHYSICIANS GROUP INC.
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:
1205540408
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1810 W US HIGHWAY 82
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75092-7069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-870-2983
Provider Business Mailing Address Fax Number:
903-870-2795

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 N 30TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLINTON
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73601-3117
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
580-323-0261
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/11/2023

Additional Information

Authorized Official

Authorized Official Last Name:
NACHIMUTHU
Authorized Official First Name:
ANBU
Authorized Official Middle Name:
Authorized Official Title or Position:
CHARIMAN/CEO
Authorized Official Telephone Number:
903-870-2745

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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