1477853935 NPI number — ADDICTION SERVICES

Table of content: (NPI 1477853935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477853935 NPI number — ADDICTION SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADDICTION SERVICES
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:
MEDPRO TREATMENT CENTERS-MCKINNEY
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:
1477853935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/11/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8444 N 90TH ST STE 100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCOTTSDALE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85258-4437
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
602-248-8886
Provider Business Mailing Address Fax Number:
602-248-8999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 N MCDONALD ST STE B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75069-3911
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-542-4144
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/29/2010

Additional Information

Authorized Official

Authorized Official Last Name:
ESBRI
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
RICHARD
Authorized Official Title or Position:
CREDENTIALING SUPERVISOR
Authorized Official Telephone Number:
480-977-1847

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QM2800X , with the licence number: 1000002 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QR0405X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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