1689608614 NPI number — BUCKNER RETIREMENT SERVICES, INC.

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 1689608614 NPI number — BUCKNER RETIREMENT SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUCKNER RETIREMENT SERVICES, INC.
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:
CALDER WOODS
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:
1689608614
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 N PEARL ST
Provider Second Line Business Mailing Address:
SUITE 1200
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75201-2824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-758-8031
Provider Business Mailing Address Fax Number:
214-758-8153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7080 CALDER AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEAUMONT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77706-6052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
409-861-1123
Provider Business Practice Location Address Fax Number:
409-861-2426
Provider Enumeration Date:
07/10/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
214-758-8031

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  113507 , 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)





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