1831138262 NPI number — PARIS MEDICAL SUPPLY, INC.

Table of content: JEFF CARLTON QUIGLEY (NPI 1235946427)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831138262 NPI number — PARIS MEDICAL SUPPLY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARIS MEDICAL SUPPLY, 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:
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:
1831138262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/29/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1515 20TH ST NE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARIS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75460-3214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-785-6615
Provider Business Mailing Address Fax Number:
903-785-7174

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1515 20TH ST NE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75460-3214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-785-6615
Provider Business Practice Location Address Fax Number:
903-785-7174
Provider Enumeration Date:
06/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
NIXON
Authorized Official First Name:
RAYMOND
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
903-785-6615

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  0034380 , 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: 517232 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 087546001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100814730A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 016286901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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