1447498019 NPI number — MANGWIRO AND ASSOCIATES PLLC

Table of content: (NPI 1447498019)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447498019 NPI number — MANGWIRO AND ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MANGWIRO AND ASSOCIATES PLLC
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:
PHRONESIS HEALTH CARE
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:
1447498019
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4321 N BELT LINE RD
Provider Second Line Business Mailing Address:
STE 500
Provider Business Mailing Address City Name:
MESQUITE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75150-3133
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-206-8904
Provider Business Mailing Address Fax Number:
214-206-8502

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4321 N BELT LINE RD
Provider Second Line Business Practice Location Address:
STE 500
Provider Business Practice Location Address City Name:
MESQUITE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75150-3133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-206-8904
Provider Business Practice Location Address Fax Number:
214-206-8502
Provider Enumeration Date:
02/04/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MANGWIRO
Authorized Official First Name:
AUDREY
Authorized Official Middle Name:
N
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-206-8904

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  051977 , 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)