1669582896 NPI number — JAIME D MURCIA MD

Table of content: (NPI 1669582896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669582896 NPI number — JAIME D MURCIA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAIME D MURCIA MD
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:
Provider Other Organization Name Type Code:
6
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:
1669582896
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/11/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 800
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79073
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-293-1555
Provider Business Mailing Address Fax Number:
806-296-5657

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2202 EDGEMERE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-293-1555
Provider Business Practice Location Address Fax Number:
806-296-5657
Provider Enumeration Date:
08/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MURCIA
Authorized Official First Name:
JAIME
Authorized Official Middle Name:
DANIEL
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
806-293-1555

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  J4661 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X , with the licence number: J4661 , 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: 063655701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 105468100 . This is a "F/C RHC" identifier . This identifiers is of the category "OTHER".
  • Identifier: 130481805 . This is a "SUPERIOR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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