1538156229 NPI number — GIBSON & HARSHAW, LLC

Table of content: (NPI 1538156229)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538156229 NPI number — GIBSON & HARSHAW, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GIBSON & HARSHAW, 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:
ASSISTCARE
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:
1538156229
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 ZEID BLVD
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75652-6069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-657-4413
Provider Business Mailing Address Fax Number:
903-655-0225

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 ZEID BLVD
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75652-6069
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-657-4413
Provider Business Practice Location Address Fax Number:
903-655-0225
Provider Enumeration Date:
09/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
GIBSON
Authorized Official First Name:
PATSY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
903-657-4413

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  006761 , 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: HH9277 . This is a "BCBS PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 006761 . This is a "STATE LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 024320601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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