1598753535 NPI number — MS. JUDY G PERDUE NP

Table of content: MS. JUDY G PERDUE NP (NPI 1598753535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598753535 NPI number — MS. JUDY G PERDUE NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PERDUE
Provider First Name:
JUDY
Provider Middle Name:
G
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
NP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
WINTER
Provider Other First Name:
JUDY
Provider Other Middle Name:
G.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
NP
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1598753535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/14/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
919 HIDDEN RDG
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75038-3813
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-282-2711
Provider Business Mailing Address Fax Number:
469-282-0996

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2510 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 106
Provider Business Practice Location Address City Name:
ALICE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78332-4187
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-661-8370
Provider Business Practice Location Address Fax Number:
361-661-8375
Provider Enumeration Date:
10/13/2005

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: 363LW0102X , with the licence number:  AP108623 , 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: 147586502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 87N572 . This is a "BCBS OLD PRACTICE SITE #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 314012 . This is a "BCBS OF WYOMING" identifier , issued by the state of ( WY ) . This identifiers is of the category "OTHER".
  • Identifier: 122331100 . This is a "FIRST CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8C9177 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 147586504 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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