1588818413 NPI number — VON L. EVANS JR., M.D., P.A.

Table of content: (NPI 1588818413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588818413 NPI number — VON L. EVANS JR., M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VON L. EVANS JR., M.D., P.A.
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:
TARRANT COUNTY BONE AND JOINT
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:
1588818413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/20/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6426
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76115-0426
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-926-2663
Provider Business Mailing Address Fax Number:
817-546-3945

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11797 SOUTH FWY
Provider Second Line Business Practice Location Address:
STE. 346
Provider Business Practice Location Address City Name:
BURLESON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76028-7026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-926-2663
Provider Business Practice Location Address Fax Number:
817-546-3945
Provider Enumeration Date:
11/05/2008

Additional Information

Authorized Official

Authorized Official Last Name:
NEAL
Authorized Official First Name:
LASEAN
Authorized Official Middle Name:
Authorized Official Title or Position:
A/R SPECIALIST
Authorized Official Telephone Number:
817-926-2663

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  H3877 , 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: 133191004 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: H3877 . This is a "LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com