1376754184 NPI number — DCOA PHYSICIAN ASSOCIATES PA

Table of content: (NPI 1376754184)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376754184 NPI number — DCOA PHYSICIAN ASSOCIATES PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DCOA PHYSICIAN ASSOCIATES PA
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:
DIABETES AMERICA
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:
1376754184
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/30/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13100 NORTHWEST FREEWAY
Provider Second Line Business Mailing Address:
STE 400
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77040-6346
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-237-3500
Provider Business Mailing Address Fax Number:
281-897-9906

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10970 SHADOW CREEK PKWY
Provider Second Line Business Practice Location Address:
SUITE 270
Provider Business Practice Location Address City Name:
PEARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77584-0100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-840-5210
Provider Business Practice Location Address Fax Number:
713-436-7721
Provider Enumeration Date:
05/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DOWLING
Authorized Official First Name:
PHILIP
Authorized Official Middle Name:
C
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
832-237-3500

Provider Taxonomy Codes

  • Taxonomy code: 207RE0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2500X , with the licence number: 00593X , 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)





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