1669495792 NPI number — NANCY J HITZFELDER MD

Table of content: NANCY J HITZFELDER MD (NPI 1669495792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669495792 NPI number — NANCY J HITZFELDER MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HITZFELDER
Provider First Name:
NANCY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1669495792
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/29/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1300 W LANCASTER
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76102-3484
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-336-2823
Provider Business Mailing Address Fax Number:
682-885-7347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1300 W LANCASTER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76102-3410
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-336-8611
Provider Business Practice Location Address Fax Number:
682-336-2823
Provider Enumeration Date:
07/26/2006

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: 2080P0008X , with the licence number:  E6098 , 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: 120503105 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 140442813 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1548230923 . This is a "GROUP NPI NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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