1336145515 NPI number — DR. JUI-LIEN CHOU M.D.

Table of content: DR. JUI-LIEN CHOU M.D. (NPI 1336145515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336145515 NPI number — DR. JUI-LIEN CHOU M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHOU
Provider First Name:
JUI-LIEN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

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:
1336145515
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2202 MEMPHIS AVE
Provider Second Line Business Mailing Address:
STE 202
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79410-1342
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4002 21ST ST
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1135
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-793-1406
Provider Business Practice Location Address Fax Number:
806-796-1167
Provider Enumeration Date:
06/22/2005

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: 2085R0001X , with the licence number:  H0985 , 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: 0X0144 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 120115401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3202252 . This is a "BLUELINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 86190G . This is a "BC/BS TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 110332100 . This is a "1ST CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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