1881702819 NPI number — HEALTHTEXAS PROVIDER NETWORK - NEUROSURGICAL ASSOCIATES, LLP

Table of content: (NPI 1881702819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881702819 NPI number — HEALTHTEXAS PROVIDER NETWORK - NEUROSURGICAL ASSOCIATES, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHTEXAS PROVIDER NETWORK - NEUROSURGICAL ASSOCIATES, LLP
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:
1881702819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/05/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8080 N CENTRAL EXPY
Provider Second Line Business Mailing Address:
SUITE 1650
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75206-1838
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-860-8648
Provider Business Mailing Address Fax Number:
972-860-8679

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1420 8TH AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-4138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-920-0003
Provider Business Practice Location Address Fax Number:
817-920-0068
Provider Enumeration Date:
08/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOURTON
Authorized Official First Name:
ELLEN
Authorized Official Middle Name:
E.
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
972-860-8649

Provider Taxonomy Codes

  • Taxonomy code: 207T00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0079LW . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1876500-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com