1619906534 NPI number — TERI A PAY N.P.

Table of content: TERI A PAY N.P. (NPI 1619906534)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619906534 NPI number — TERI A PAY N.P.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PAY
Provider First Name:
TERI
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
N.P.
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:
1619906534
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/15/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
916 N CREST RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAMPA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79065-2798
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-662-3613
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 N PRICE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAMPA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79065-5126
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-688-2273
Provider Business Practice Location Address Fax Number:
806-665-0537
Provider Enumeration Date:
07/02/2006

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: 363L00000X , with the licence number:  45736 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 739475 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X , with the licence number: 739475 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LP0200X , with the licence number: 739475 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 201311203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200308720 A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200347480C , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 201311202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 161690 . This is a "BCBS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
  • Identifier: 01409751 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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