1548394679 NPI number — MOTHERS' MILK BANK OF NORTH TEXAS, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548394679 NPI number — MOTHERS' MILK BANK OF NORTH TEXAS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MOTHERS' MILK BANK OF NORTH TEXAS, INC.
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:
1548394679
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 W LANCASTER AVE
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76102-3410
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-810-0071
Provider Business Mailing Address Fax Number:
817-810-0087

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 W LANCASTER AVE
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76102-3410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-810-0071
Provider Business Practice Location Address Fax Number:
817-810-0087
Provider Enumeration Date:
03/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SWARD-COMUENLLI
Authorized Official First Name:
SUSAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT OF THE BOARD OF DIRESTORS
Authorized Official Telephone Number:
817-810-0071

Provider Taxonomy Codes

  • Taxonomy code: 132700000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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





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