1215066303 NPI number — NORTH TEXAS NEUROSCIENCE CENTER, P.A.

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 1215066303 NPI number — NORTH TEXAS NEUROSCIENCE CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH TEXAS NEUROSCIENCE CENTER, P.A.
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:
1215066303
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/22/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
405 STATE HIGHWAY 121 BYP
Provider Second Line Business Mailing Address:
BUILDING A STE 150
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75067-8214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-869-3448
Provider Business Mailing Address Fax Number:
972-869-9915

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7301 STATE HIGHWAY 161
Provider Second Line Business Practice Location Address:
STE 160
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75039-2816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-869-3448
Provider Business Practice Location Address Fax Number:
972-409-7729
Provider Enumeration Date:
03/05/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SALMON
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-869-3448

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 109401302 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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