1679510499 NPI number — VPA OF TEXAS PLLC

Table of content: (NPI 1679510499)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679510499 NPI number — VPA OF TEXAS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VPA OF TEXAS PLLC
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:
HARMONYCARES MEDICAL GROUP
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:
1679510499
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 639295 DEPT 93386
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45263-9295
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-824-6622
Provider Business Mailing Address Fax Number:
248-324-1477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4545 FULLER DRIVE
Provider Second Line Business Practice Location Address:
SUITE 325
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75038-6521
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-870-5511
Provider Business Practice Location Address Fax Number:
972-870-5512
Provider Enumeration Date:
06/01/2006

Additional Information

Authorized Official

Authorized Official Last Name:
STEVENS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
248-824-6000

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 174974904 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DD4967 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0002MU . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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