1235578113 NPI number — CLOVER SYSTEMS LLC

Table of content: (NPI 1235578113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235578113 NPI number — CLOVER SYSTEMS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLOVER SYSTEMS LLC
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:
DENTON DIAGNOSTICS & REHAB
Provider Other Organization Name Type Code:
3
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:
1235578113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2530 LIBERTY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76209-1541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-227-2300
Provider Business Mailing Address Fax Number:
214-224-0835

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
721 S INTERSTATE 35 E
Provider Second Line Business Practice Location Address:
SUITE #140
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76205-8153
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-239-9202
Provider Business Practice Location Address Fax Number:
214-224-0835
Provider Enumeration Date:
06/24/2013

Additional Information

Authorized Official

Authorized Official Last Name:
DARNER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
DC
Authorized Official Telephone Number:
214-227-2300

Provider Taxonomy Codes

  • Taxonomy code: 111NN0400X , with the licence number:  5958 , 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)

  • Identifier: 1275830408 . This is a "NPI ( INDIVIDUAL ) DR MARK DARNER DC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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