1306065057 NPI number — MR. CODY GENE KNIFFEN-ENGLISH FITTER & DISPENSER

Table of content: MR. CODY GENE KNIFFEN-ENGLISH FITTER & DISPENSER (NPI 1306065057)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306065057 NPI number — MR. CODY GENE KNIFFEN-ENGLISH FITTER & DISPENSER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KNIFFEN-ENGLISH
Provider First Name:
CODY
Provider Middle Name:
GENE
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
FITTER & DISPENSER
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ENGLISH
Provider Other First Name:
CODY
Provider Other Middle Name:
GENE
Provider Other Name Prefix Text:
MR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FITTER & DISPENSER
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1306065057
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4150 SOUTHWEST DR
Provider Second Line Business Mailing Address:
SUITE 114
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79606-8222
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-691-9074
Provider Business Mailing Address Fax Number:
325-692-3311

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4150 SOUTHWEST DR
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79606-8222
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-691-9074
Provider Business Practice Location Address Fax Number:
325-692-3311
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 237700000X , with the licence number:  50628 , 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: 531242 . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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