1467487009 NPI number — SCOOTER STORE - DALLAS LTD.

Table of content: KATHERINE NICOLE EBEL PHARMD (NPI 1194381756)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467487009 NPI number — SCOOTER STORE - DALLAS LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SCOOTER STORE - DALLAS LTD.
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:
1467487009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/01/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 310709
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW BRAUNFELS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78131-0709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2930 SKYWAY CIR N BLDG B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75038-3509
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-756-1234
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
CONE
Authorized Official First Name:
JASON
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL COUNSEL & SECRETARY
Authorized Official Telephone Number:
830-627-4433

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 149329801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149329803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149329802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 149329804 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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