1821049560 NPI number — ARLINGTON NEUROLOGY ASSOC

Table of content: (NPI 1821049560)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821049560 NPI number — ARLINGTON NEUROLOGY ASSOC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARLINGTON NEUROLOGY ASSOC
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:
1821049560
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
912 WRIGHT ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76012-4759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-274-7593
Provider Business Mailing Address Fax Number:
817-261-4785

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
912 WRIGHT ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76012-4759
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-274-7593
Provider Business Practice Location Address Fax Number:
817-261-4785
Provider Enumeration Date:
05/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GANDHI
Authorized Official First Name:
RAJENDRA
Authorized Official Middle Name:
P
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-274-7593

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  F7761 , 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: 0005DU . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1766263-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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