1437219995 NPI number — J KEITH PRESTON MD PA

Table of content: (NPI 1437219995)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437219995 NPI number — J KEITH PRESTON MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J KEITH PRESTON MD 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:
REGIONAL NEUROSURGICAL ASSOCIATES
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:
1437219995
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/03/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4015 LAMAR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARIS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75462-5212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-784-7959
Provider Business Mailing Address Fax Number:
903-784-7969

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4015 LAMAR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75462-5212
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-784-7959
Provider Business Practice Location Address Fax Number:
903-784-7969
Provider Enumeration Date:
12/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PRESTON
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
KEITH
Authorized Official Title or Position:
PRESIDENT/PHYSICIAN
Authorized Official Telephone Number:
903-784-7959

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X , with the licence number:  L5880 , 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: 00X132 . This is a "MEDICARE" identifier . This identifiers is of the category "OTHER".




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