1518106475 NPI number — ORTHOVENTURES LLC

Table of content: MARK A. DAVIS O.D. (NPI 1124154505)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518106475 NPI number — ORTHOVENTURES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ORTHOVENTURES LLC
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:
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:
1518106475
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/16/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3010 GAYLORD PKWY
Provider Second Line Business Mailing Address:
STE 240
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75034-8664
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-309-8900
Provider Business Mailing Address Fax Number:
972-309-8930

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3010 GAYLORD PKWY
Provider Second Line Business Practice Location Address:
STE 240
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75034-8664
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-309-8900
Provider Business Practice Location Address Fax Number:
972-309-8930
Provider Enumeration Date:
02/16/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FRICKE
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
T
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
972-309-8907

Provider Taxonomy Codes

  • Taxonomy code: 332900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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