1871973867 NPI number — IRVING COPPELL PRIMARY CARE DOCTORS PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871973867 NPI number — IRVING COPPELL PRIMARY CARE DOCTORS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IRVING COPPELL PRIMARY CARE DOCTORS PLLC
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:
1871973867
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 15885
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BELFAST
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04915-4053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-905-3915
Provider Business Mailing Address Fax Number:
940-205-4525

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
309 REGENCY PKWY
Provider Second Line Business Practice Location Address:
SUITE #107
Provider Business Practice Location Address City Name:
MANSFIELD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76063-5165
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-905-3915
Provider Business Practice Location Address Fax Number:
940-205-4525
Provider Enumeration Date:
06/04/2015

Additional Information

Authorized Official

Authorized Official Last Name:
RAGHU
Authorized Official First Name:
VIJAYALAKSHMI
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/PROVIDER
Authorized Official Telephone Number:
972-905-3915

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2024 www.npivalidator.com