1356640205 NPI number — SHERI HATT LPO, BOCPO

Table of content: SHERI HATT LPO, BOCPO (NPI 1356640205)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356640205 NPI number — SHERI HATT LPO, BOCPO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HATT
Provider First Name:
SHERI
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPO, BOCPO
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:
1356640205
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
962 HIGHWAY 71 EAST
Provider Second Line Business Mailing Address:
STE 3-102
Provider Business Mailing Address City Name:
BASTROP
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78602-5023
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-412-6322
Provider Business Mailing Address Fax Number:
512-651-0349

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
962 HIGHWAY 71 EAST
Provider Second Line Business Practice Location Address:
STE. 3-102
Provider Business Practice Location Address City Name:
BASTROP
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-412-6322
Provider Business Practice Location Address Fax Number:
512-651-0349
Provider Enumeration Date:
03/17/2011

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: 222Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 224P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 347013001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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