1821005539 NPI number — YAW B FRIMPONG-BADU MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821005539 NPI number — YAW B FRIMPONG-BADU MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

FRIMPONG-BADU

Provider First Name:

YAW

Provider Middle Name:

B

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1821005539

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/11/2018

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

17201 I H 45 S

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

SHENANDOAH

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

77385-3311

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

936-270-2099

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

17201 I H 45 S

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

SHENANDOAH

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

77385

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

936-270-2099

Provider Business Practice Location Address Fax Number:

Provider Enumeration Date:

08/02/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  232973 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RG0300X , with the licence number: M9289 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 208M00000X , with the licence number: M9289 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 2580615 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: TIN . This is a "HORIZON HEALTHCARE" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 0587997 . This is a "CIGNA" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 1078431 . This is a "AETNA - HMO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 4C8141 . This is a "HEALTH NET" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: P3631301 . This is a "OXFORD HEALTH PLANS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: TIN . This is a "MULTIPLAN" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 199657104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 326AP2 . This is a "EMPIRE BC/BS" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".
• Identifier: 7192773 . This is a "AETNA - PPO" identifier , issued by the state of ( NY ) . This identifiers is of the category "OTHER".