1568486264 NPI number — OBSTETRIX MEDICAL GROUP OF TEXAS BILLING, INC.

Table of content: (NPI 1568486264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568486264 NPI number — OBSTETRIX MEDICAL GROUP OF TEXAS BILLING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OBSTETRIX MEDICAL GROUP OF TEXAS BILLING, 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:
OBSTETRIX MEDICAL GROUP OF 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:
1568486264
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 CONCORD TER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUNRISE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33323-2843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-384-0175
Provider Business Mailing Address Fax Number:
954-851-1948

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3001 E PRESIDENT GEORGE BUSH HWY
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
RICHARDSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75082-3542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-437-5099
Provider Business Practice Location Address Fax Number:
972-764-1661
Provider Enumeration Date:
07/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DWYER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
D
Authorized Official Title or Position:
ASSISTANT SECRETARY
Authorized Official Telephone Number:
954-384-0175

Provider Taxonomy Codes

  • Taxonomy code: 207VM0101X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00291Z . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 7029142 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 79601B001 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 76015A001 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 81106343 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00022K . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 76104A001 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00022K . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00454R . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 31438750 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 079584101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100726580A , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100726620A , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 177389701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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