1821189945 NPI number — COMPREHENSIVE BREAST CARE CENTER OF TEXAS INC

Table of content: DR. MATTHEW THOMAS LEWIS M.D. (NPI 1205987831)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821189945 NPI number — COMPREHENSIVE BREAST CARE CENTER OF TEXAS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE BREAST CARE CENTER OF TEXAS INC
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:
6
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:
1821189945
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15601 DALLAS PKWY
Provider Second Line Business Mailing Address:
STE. 500
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-3353
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-398-4100
Provider Business Mailing Address Fax Number:
469-398-4189

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3801 W 15TH ST STE C
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75075-7775
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-596-4033
Provider Business Practice Location Address Fax Number:
972-985-9649
Provider Enumeration Date:
09/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
POLFREMAN
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
469-398-4110

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 143932501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".