1346223005 NPI number — MARGO DENKE GRIFFIN

Table of content: MARGO DENKE GRIFFIN (NPI 1346223005)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346223005 NPI number — MARGO DENKE GRIFFIN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIFFIN
Provider First Name:
MARGO
Provider Middle Name:
DENKE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DENKE
Provider Other First Name:
MARGO
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1346223005
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/25/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11035 FM 470
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TARPLEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78883-6307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-562-3379
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11035 FM 470
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TARPLEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78883-6307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-562-3379
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/26/2005

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: 207RE0101X , with the licence number:  H1760 , 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: 046958702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0079JL . This is a "BCBS PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2315180 . This is a "ALTERNATIVE ID BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".