1588855761 NPI number — DR. KIMBERLY VOGEL COONFIELD MD

Table of content: MRS. AMANDA DIANE FLAMING LPC (NPI 1942322532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588855761 NPI number — DR. KIMBERLY VOGEL COONFIELD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
COONFIELD
Provider First Name:
KIMBERLY
Provider Middle Name:
VOGEL
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1588855761
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/14/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2520 B F TERRY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROSENBERG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77471-5636
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-342-6006
Provider Business Mailing Address Fax Number:
281-239-7554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2100 REGIONAL MEDICAL DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHARTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77488
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-532-1700
Provider Business Practice Location Address Fax Number:
979-532-4584
Provider Enumeration Date:
08/05/2007

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: 207R00000X , with the licence number:  N4995 , 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: 215204301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 215204305 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8DE522 . This is a "BC/BS #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00896923 . This is a "RAILROAD-MEDICARE #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P01090444 . This is a "RAILROAD MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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