1841382363 NPI number — MP TOTALCARE MEDICAL, INC.

Table of content: (NPI 1841382363)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841382363 NPI number — MP TOTALCARE MEDICAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MP TOTALCARE MEDICAL, 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:
CCS MEDICAL
Provider Other Organization Name Type Code:
3
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:
1841382363
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1505 LBJ FREEWAY
Provider Second Line Business Mailing Address:
SUITE 600
Provider Business Mailing Address City Name:
FARMERS BRANCH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75234-6074
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-628-2100
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3505 KOGER BLVD.
Provider Second Line Business Practice Location Address:
SUITE 220
Provider Business Practice Location Address City Name:
DULUTH
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30096-7671
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
770-407-4430
Provider Business Practice Location Address Fax Number:
866-387-8451
Provider Enumeration Date:
09/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAINES
Authorized Official First Name:
MONICA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
DIRECTOR/SECRETARY
Authorized Official Telephone Number:
972-628-2100

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 009305140 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 111086100 , issued by the state of ( WY ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1970557 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 9502459-00 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: DME593 , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100798850A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207944 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 795517100 , issued by the state of ( MN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8106908 , issued by the state of ( NJ ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0761892-02 CSHCN , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0962196 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 100005220A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 30008023 , issued by the state of ( NH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 332558000 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3870001 , issued by the state of ( RI ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0014731660004 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 141828701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180770000 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1841382363 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 866585 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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