1700886264 NPI number — DR. GEORGE CHRIS BAKATSAS DPM

Table of content: DR. GEORGE CHRIS BAKATSAS DPM (NPI 1700886264)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700886264 NPI number — DR. GEORGE CHRIS BAKATSAS DPM

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKATSAS
Provider First Name:
GEORGE
Provider Middle Name:
CHRIS
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DPM
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BAKATSAS
Provider Other First Name:
GEORGE
Provider Other Middle Name:
CHRIS
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
DPM
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1700886264
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/03/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 98
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WOLFFORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79382-0098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-300-0134
Provider Business Mailing Address Fax Number:
806-300-0851

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6849 82ND STREET
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79424
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-300-0134
Provider Business Practice Location Address Fax Number:
806-300-0851
Provider Enumeration Date:
07/27/2005

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: 213E00000X , with the licence number:  1316 , 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: 092745101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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