1700226024 NPI number — SPEECH THERAPY SERVICES, P. C.

Table of content: DR. TRUC LE JR. D.O. (NPI 1093714388)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700226024 NPI number — SPEECH THERAPY SERVICES, P. C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SPEECH THERAPY SERVICES, P. C.
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:
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:
1700226024
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/04/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
502 WHEAT AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAINBRIDGE
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
39819-4325
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-246-4088
Provider Business Mailing Address Fax Number:
229-246-0205

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
502 WHEAT AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAINBRIDGE
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
39819-4325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-246-4088
Provider Business Practice Location Address Fax Number:
229-246-0205
Provider Enumeration Date:
07/01/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PARKER
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
ANN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
229-246-4088

Provider Taxonomy Codes

  • Taxonomy code: 235Z00000X , with the licence number:  SLP000738 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000626392B , issued by the state of ( GA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 340266 . This is a "WELLCARE PROVIDER NUMBER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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