1881653079 NPI number — MR. MARK A HORNSBY CRNA

Table of content: MR. MARK A HORNSBY CRNA (NPI 1881653079)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881653079 NPI number — MR. MARK A HORNSBY CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HORNSBY
Provider First Name:
MARK
Provider Middle Name:
A
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

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:
1881653079
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1130
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENVER CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79323-1130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-592-2121
Provider Business Mailing Address Fax Number:
806-592-5489

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
412 MUSTANG DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENVER CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79323-2762
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-592-2121
Provider Business Practice Location Address Fax Number:
806-592-5489
Provider Enumeration Date:
03/17/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 367500000X , with the licence number:  NA2773 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 367500000X , with the licence number: AP112316 , 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: 184258501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 86896U . This is a "BCBSTX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: RN5543380 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1D4636 . This is a "NOVITAS - 855I" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1D4636 . This is a "855R" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".