1811997364 NPI number — DR. SIMON JOHN FORSTER DC, DABCO

Table of content: (NPI 1811236557)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1811997364 NPI number — DR. SIMON JOHN FORSTER DC, DABCO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FORSTER
Provider First Name:
SIMON
Provider Middle Name:
JOHN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
DC, DABCO
Provider Gender Code:
M

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:
1811997364
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12414 ALDERBROOK DR
Provider Second Line Business Mailing Address:
STE. 250
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78758-2480
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-834-2355
Provider Business Mailing Address Fax Number:
512-834-0477

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12414 ALDERBROOK DR
Provider Second Line Business Practice Location Address:
STE. 250
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78758-2480
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-834-2355
Provider Business Practice Location Address Fax Number:
512-834-0477
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: 111NX0800X , with the licence number:  5724 , 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: 603720 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8F9211 . This is a "INDIV BCBS #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 432327 . This is a "ACN #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0011HW . This is a "GROUP BCBS #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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