1710364575 NPI number — T.E.A.M.

Table of content: (NPI 1710364575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710364575 NPI number — T.E.A.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
T.E.A.M.
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:
1710364575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1140 EMPIRE CENTRAL BLVD
Provider Second Line Business Mailing Address:
520
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75247
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-301-0968
Provider Business Mailing Address Fax Number:
214-242-2224

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1140 EMPIRE CENTRAL BLVD
Provider Second Line Business Practice Location Address:
520
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75247
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-301-0968
Provider Business Practice Location Address Fax Number:
214-242-2224
Provider Enumeration Date:
04/30/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
COBB PIGGEE
Authorized Official First Name:
JANET
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
214-458-7806

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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