1558478313 NPI number — CLINICAL PEDIATRIC ASSOCIATES OF IRVING & LAS COLINAS PA

Table of content: JOE BRYAN BLACKWELL RPH (NPI 1376888784)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558478313 NPI number — CLINICAL PEDIATRIC ASSOCIATES OF IRVING & LAS COLINAS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL PEDIATRIC ASSOCIATES OF IRVING & LAS COLINAS PA
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:
CLINICAL PEDIATRIC ASSOCIATES OF NORTH TEXAS
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:
1558478313
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2020 W STATE HIGHWAY 114 STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GRAPEVINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76051-8648
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-331-7200
Provider Business Mailing Address Fax Number:
972-331-4858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2020 W STATE HIGHWAY 114 STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GRAPEVINE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76051-8648
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-331-7200
Provider Business Practice Location Address Fax Number:
972-331-4858
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZOLLO
Authorized Official First Name:
ADRIENNE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
972-331-7200

Provider Taxonomy Codes

  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com