1225398985 NPI number — D. JALANE BAKER EDDINS, CRNA, PC

Table of content: DR. MOIRA GINI GROH D.D.S (NPI 1871850131)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225398985 NPI number — D. JALANE BAKER EDDINS, CRNA, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
D. JALANE BAKER EDDINS, CRNA, PC
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:
1225398985
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/29/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 515432
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:
75251-5432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-549-6998
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 OHIO DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093-5208
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-549-6998
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/29/2012

Additional Information

Authorized Official

Authorized Official Last Name:
EDDINS
Authorized Official First Name:
DARLA
Authorized Official Middle Name:
JALANE
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-549-6998

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  538008 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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