1639101108 NPI number — TH HEALTHCARE, LTD.

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 1639101108 NPI number — TH HEALTHCARE, LTD.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TH HEALTHCARE, LTD.
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:
SHELBY REGIONAL MEDICAL CENTER
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:
1639101108
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 849775
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75284-9775
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-560-3186
Provider Business Mailing Address Fax Number:
936-598-4237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
602 HURST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75935-3414
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-659-8278
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/07/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ABERCROMBIE
Authorized Official First Name:
ZACH
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
205-620-7095

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  000423 , 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: 133465802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 133465808 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1734705 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 114113 . This is a "CHIP SUPERIOR HEALTH PLAN" identifier . This identifiers is of the category "OTHER".
  • Identifier: 133465809 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000412 . This is a "HUMANA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 077747670 . This is a "AETNA US HEALTHCARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: HH0609 . This is a "BCBS OF TEXAS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com