1417243395 NPI number — TORCHWOOD, LLC

Table of content: (NPI 1417243395)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417243395 NPI number — TORCHWOOD, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TORCHWOOD, LLC
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:
1417243395
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/20/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2530 LIBERTY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76209-1541
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-484-2525
Provider Business Mailing Address Fax Number:
512-366-9789

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 S I-35 E
Provider Second Line Business Practice Location Address:
L22
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76205-8192
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-484-2525
Provider Business Practice Location Address Fax Number:
512-366-9789
Provider Enumeration Date:
06/20/2011

Additional Information

Authorized Official

Authorized Official Last Name:
DARNER
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
GEN MANAGER
Authorized Official Telephone Number:
940-484-2525

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  5958 , 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: 1275830408 . This is a "NPI TYPE -1 FOR DR MARK DARNER DC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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