1598093742 NPI number — JOHN T. MELVIN, M.D. & ASSOCIATES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598093742 NPI number — JOHN T. MELVIN, M.D. & ASSOCIATES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN T. MELVIN, M.D. & ASSOCIATES
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:
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:
1598093742
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 854
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75653-0854
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-657-1251
Provider Business Mailing Address Fax Number:
903-657-3122

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 N HIGH ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75652-5983
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-657-1251
Provider Business Practice Location Address Fax Number:
903-657-3122
Provider Enumeration Date:
11/30/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MERRITT
Authorized Official First Name:
REBECCA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
903-657-1251

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  G5370 , 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: 110139601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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