1497902498 NPI number — MARY BISHOP PRICE MD

Table of content: BRIAN MICHAEL THATCHER LCDC-III (NPI 1538405006)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497902498 NPI number — MARY BISHOP PRICE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PRICE
Provider First Name:
MARY
Provider Middle Name:
BISHOP
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1497902498
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/22/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 841656
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-1656
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-531-5000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 E DAWSON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75701-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-531-4500
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X , with the licence number:  BP10025438 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: N1422 , 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: 199091305 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 75-2616977-001 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 750818167022 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TIN PLUS 015 . This is a "TRICARE TYLER LOCATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8BP168 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8DF420 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 199091308 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00735134 . This is a "RAIL ROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P01304485 . This is a "RAIL ROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 199091304 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 199091307 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8DU722 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 75-0818167-048 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 75-2616977-002 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 75-2616977-028 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8BZ886 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TIN PLUS 044 . This is a "TRICARE WINNSBORO LOCATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TIN PLUS 005 . This is a "TRICARE JACKSONVILLE LOCATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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