1235285289 NPI number — TOWN OF LITTLE ELM

Table of content: (NPI 1235285289)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235285289 NPI number — TOWN OF LITTLE ELM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWN OF LITTLE ELM
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:
6
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:
1235285289
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 W ELDORADO PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LITTLE ELM
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75068-5060
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-975-0420
Provider Business Mailing Address Fax Number:
214-975-0776

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
101 HARDWICKE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LITTLE ELM
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75068-5202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-975-0420
Provider Business Practice Location Address Fax Number:
214-975-0420
Provider Enumeration Date:
01/25/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FLORENTINO
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
Authorized Official Title or Position:
EMS DIRECTOR
Authorized Official Telephone Number:
214-795-0420

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  61007 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 341600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 508920 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 000236201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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