1497868293 NPI number — PATRICK KWAN M D P A

Table of content: (NPI 1497868293)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497868293 NPI number — PATRICK KWAN M D P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATRICK KWAN M D P A
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:
RED RIVER MEDICAL CENTER
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:
1497868293
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 N GRAND AVE
Provider Second Line Business Mailing Address:
STE 4
Provider Business Mailing Address City Name:
GAINESVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76240-3574
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-665-0683
Provider Business Mailing Address Fax Number:
940-668-2663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 N GRAND AVE
Provider Second Line Business Practice Location Address:
STE 4
Provider Business Practice Location Address City Name:
GAINESVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76240-3574
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-665-0683
Provider Business Practice Location Address Fax Number:
940-668-2663
Provider Enumeration Date:
08/16/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KWAN
Authorized Official First Name:
PATRICK
Authorized Official Middle Name:
K
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
940-665-0683

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , with the licence number:  G2415 , 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: 0050PU . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 063665601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 106022 . This is a "CHIP SUPERIOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".