1770559973 NPI number — UNIVERSITY OF TEXAS AT DALLAS

Table of content: (NPI 1770559973)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770559973 NPI number — UNIVERSITY OF TEXAS AT DALLAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNIVERSITY OF TEXAS AT DALLAS
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:
UTD CALLIER CENTER FOR COMMUNICATION DISORDERS
Provider Other Organization Name Type Code:
3
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:
1770559973
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1966 INWOOD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75235-7205
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-883-3010
Provider Business Mailing Address Fax Number:
972-883-3022

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1966 INWOOD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75235-7205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-883-3000
Provider Business Practice Location Address Fax Number:
972-883-3016
Provider Enumeration Date:
02/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ELIZONDO
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE SERVICES OFFICER I
Authorized Official Telephone Number:
972-883-3010

Provider Taxonomy Codes

  • Taxonomy code: 231H00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 235Z00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 010066 0001 . This is a "PACIFICCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 082309801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 542184706 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0051BT . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 142931801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: CG3488 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 566299 . This is a "UNITED" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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