1457492613 NPI number — WREN ENTERPRISES, INC

Table of content: (NPI 1457492613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457492613 NPI number — WREN ENTERPRISES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WREN ENTERPRISES, 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:
AA MOBILITY
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:
1457492613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3070
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FLINT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75762-3050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-825-6098
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16870 MARY MARTIN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FLINT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75762-8800
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-825-6098
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/09/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PRIEST
Authorized Official First Name:
DAN
Authorized Official Middle Name:
WREN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
903-825-6098

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , 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: 175416002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0079677 . This is a "TX STATE MEDICAL DEVICE D" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 532057 . This is a "BLUE CROSS BLUE SHIELD PR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".