1467661595 NPI number — HEART CENTER OF NORTH TEXAS, PA

Table of content: DR. DARREN DEANDRE NAUGLES MD (NPI 1013141118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467661595 NPI number — HEART CENTER OF NORTH TEXAS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART CENTER OF NORTH TEXAS, 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:
HEART CENTER OF NORTH TEXAS
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:
1467661595
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1017 12TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76104-3915
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-334-2800
Provider Business Mailing Address Fax Number:
817-820-0094

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1200 CRAWFORD AVE STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRANBURY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76048-4560
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-334-2800
Provider Business Practice Location Address Fax Number:
817-820-0094
Provider Enumeration Date:
05/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MADDEN
Authorized Official First Name:
SYDNEY
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
817-334-2800

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 109377503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00455K . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 5930155 . This is a "AETNA GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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