1396851952 NPI number — THERAPY SERVICES ASSOCIATES, PROFESSIONAL CORP

Table of content: (NPI 1396851952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396851952 NPI number — THERAPY SERVICES ASSOCIATES, PROFESSIONAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THERAPY SERVICES ASSOCIATES, PROFESSIONAL CORP
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:
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:
1396851952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 811
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOVINGTON
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88260-0811
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
575-396-8540
Provider Business Mailing Address Fax Number:
575-396-2187

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2700 N GRIMES ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOBBS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88240-1816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
575-392-4129
Provider Business Practice Location Address Fax Number:
575-392-3835
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
MELANIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CONTROLLER
Authorized Official Telephone Number:
575-396-8540

Provider Taxonomy Codes

  • Taxonomy code: 225X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2000X , with the licence number: 6592 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: L5784 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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