1740237148 NPI number — ALVORD MEDICAL CLINIC, PA

Table of content: (NPI 1902049158)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1740237148 NPI number — ALVORD MEDICAL CLINIC, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALVORD MEDICAL CLINIC, PA
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:
1740237148
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/01/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 49
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALVORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76225-0049
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-427-2858
Provider Business Mailing Address Fax Number:
940-427-2857

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
115 E BYPASS 287
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
ALVORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76225-7778
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-427-2858
Provider Business Practice Location Address Fax Number:
940-427-2857
Provider Enumeration Date:
05/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALLING
Authorized Official First Name:
JEFFERSON
Authorized Official Middle Name:
B
Authorized Official Title or Position:
MD/OWNER
Authorized Official Telephone Number:
940-627-7829

Provider Taxonomy Codes

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

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

  • Identifier: 453934 . This is a "MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 175292501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF4050 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 111571903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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