1417215989 NPI number — NORTH TEXAS AREA COMMUNITY HEALTH CENTERS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417215989 NPI number — NORTH TEXAS AREA COMMUNITY HEALTH CENTERS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH TEXAS AREA COMMUNITY HEALTH CENTERS, INC.
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:
6
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:
1417215989
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/12/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
10/23/2013
NPI Reactivation Date:
01/12/2015

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2100 N MAIN ST
Provider Second Line Business Mailing Address:
SUITE 107
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76164-8570
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-378-0855
Provider Business Mailing Address Fax Number:
817-378-0861

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2000 S FM 51
Provider Second Line Business Practice Location Address:
SUITE D
Provider Business Practice Location Address City Name:
DECATUR
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76234-3702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-393-0100
Provider Business Practice Location Address Fax Number:
940-393-0199
Provider Enumeration Date:
05/02/2012

Additional Information

Authorized Official

Authorized Official Last Name:
VIVEROS
Authorized Official First Name:
ARCADIO
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
817-378-0855

Provider Taxonomy Codes

  • Taxonomy code: 261QF0400X , 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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