1528236544 NPI number — PERRYTON HEALTH CENTER

Table of content: CIERA BUZZELL RDN, CD (NPI 1134586977)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528236544 NPI number — PERRYTON HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PERRYTON HEALTH CENTER
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:
1528236544
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1501 S TAYLOR ST
Provider Second Line Business Mailing Address:
C/O TEXAS PANHANDLE FAMILY PLANNING AND HEALTH CENTERS
Provider Business Mailing Address City Name:
AMARILLO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79101-4307
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-372-8731
Provider Business Mailing Address Fax Number:
806-372-8746

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1501 S TAYLOR ST
Provider Second Line Business Practice Location Address:
C/O TEXAS PANHANDLE FAMILY PLANNING AND HEALTH CENTERS
Provider Business Practice Location Address City Name:
AMARILLO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79101-4307
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-372-8731
Provider Business Practice Location Address Fax Number:
806-372-8731
Provider Enumeration Date:
02/12/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SCHAFFNER
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
LEROY
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
806-435-3606

Provider Taxonomy Codes

  • Taxonomy code: 261QA0005X , with the licence number:  L9981 , 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: 092107402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".