1629245030 NPI number — JULIE L. REIHSEN M.D./PA

Table of content: (NPI 1629245030)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629245030 NPI number — JULIE L. REIHSEN M.D./PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JULIE L. REIHSEN M.D./PA
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:
DALLAS FAMILY MEDICAL
Provider Other Organization Name Type Code:
3
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:
1629245030
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
16901 DALLAS PKWY
Provider Second Line Business Mailing Address:
STE 208
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-5226
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-248-2020
Provider Business Mailing Address Fax Number:
972-248-2028

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
16901 DALLAS PKWY
Provider Second Line Business Practice Location Address:
STE 208
Provider Business Practice Location Address City Name:
ADDISON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75001-5226
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-248-2020
Provider Business Practice Location Address Fax Number:
972-248-2028
Provider Enumeration Date:
05/14/2008

Additional Information

Authorized Official

Authorized Official Last Name:
REIHSEN
Authorized Official First Name:
JULIE
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER/ DOCTOR
Authorized Official Telephone Number:
972-248-2020

Provider Taxonomy Codes

  • Taxonomy code: 208D00000X , with the licence number:  J5457 , 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: 0007QF . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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