1215995816 NPI number — CLINICAL PARTNERS PA

Table of content: (NPI 1215995816)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215995816 NPI number — CLINICAL PARTNERS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL PARTNERS PA
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:
1215995816
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/20/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13737 NOEL RD STE 1600
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75240-1374
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-838-2371
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2606 HOSPITAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78405-1818
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-939-7440
Provider Business Practice Location Address Fax Number:
903-663-3629
Provider Enumeration Date:
05/03/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KONDAS
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
954-838-2371

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 367500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 158449 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1040096 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 154242502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 175305002 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200097310A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 25109847 , issued by the state of ( CO ) . This identifiers is of the category "MEDICAID".




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