1528122686 NPI number — MARY MATHAI WHCNP

Table of content: MARY MATHAI WHCNP (NPI 1528122686)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528122686 NPI number — MARY MATHAI WHCNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MATHAI
Provider First Name:
MARY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
WHCNP
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:
1528122686
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/06/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 660599
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:
75266-0599
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3320 LIVE OAK ST FL 5
Provider Second Line Business Practice Location Address:
EAST DALLAS WOMEN'S HEALTH CENTER
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75204-6109
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-266-1200
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/21/2006

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: 363LW0102X , with the licence number:  592720 , 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: 197049301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 197049305 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 197049310 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 197049308 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 197049309 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 197049307 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 197049304 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 197049306 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8Y3522 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com