1609822667 NPI number — GARY SEGHI D.C.

Table of content: GARY SEGHI D.C. (NPI 1609822667)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609822667 NPI number — GARY SEGHI D.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SEGHI
Provider First Name:
GARY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.C.
Provider Gender Code:
M

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:
1609822667
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/28/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1613 W 6TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78703-5075
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-478-1613
Provider Business Mailing Address Fax Number:
512-478-1752

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1613 W 6TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78703-5075
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-478-1613
Provider Business Practice Location Address Fax Number:
512-478-1752
Provider Enumeration Date:
05/25/2006

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: 111N00000X , with the licence number:  DC2668 , 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: 0011314-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DC2668 . This is a "PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 74-2286938 . This is a "TAX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 601053 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com