1588388565 NPI number — DANIELLE ELIZABETH METCALF PA-C

Table of content: DANIELLE ELIZABETH METCALF PA-C (NPI 1588388565)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588388565 NPI number — DANIELLE ELIZABETH METCALF PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
METCALF
Provider First Name:
DANIELLE
Provider Middle Name:
ELIZABETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EBZERY
Provider Other First Name:
DANIELLE
Provider Other Middle Name:
ELIZABETH
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588388565
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
912 THOMAS ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAK PARK
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60302-1509
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
774-254-6428
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SUGAR CREEK CENTER BLVD STE 618
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77478-3540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-655-4141
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2022

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 8UC133 . This is a "BLUE STAR SURGICAL ASSISTANTS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8UC392 . This is a "US MSO" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8TR726 . This is a "UNIVERSAL SURGICAL ASSISTANTS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8UC167 . This is a "XCITE SURGICAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8UC375 . This is a "UNIVERSAL SURGICAL PARTNERS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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