1750311163 NPI number — DR. SHEILA MICHELLE CARLEY-HARRIS DC

Table of content: DR. SHEILA MICHELLE CARLEY-HARRIS DC (NPI 1750311163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1750311163 NPI number — DR. SHEILA MICHELLE CARLEY-HARRIS DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CARLEY-HARRIS
Provider First Name:
SHEILA
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC
Provider Gender Code:
F

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:
1750311163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/28/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4217 FAIRWAY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA FALLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76308-2454
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-228-7512
Provider Business Mailing Address Fax Number:
940-696-0475

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4217 FAIRWAY BLVD.
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA FALLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76308-0444
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-228-7512
Provider Business Practice Location Address Fax Number:
940-696-0475
Provider Enumeration Date:
07/03/2006

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: 111N00000X , with the licence number:  9256 , 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: 176683401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8G5331 . This is a "BLUE CROSS BLUE SHIELD INDIVIDUAL PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0006JF . This is a "BLUE CROSS BLUE SHIELD GROUP PROVIDER NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 111N00000X . This is a "TAXONOMY NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1902090236 . This is a "GROUP NPI NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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