1912308271 NPI number — TX DIGESTIVE DISEASE CONSULTANTS

Table of content: (NPI 1912308271)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912308271 NPI number — TX DIGESTIVE DISEASE CONSULTANTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TX DIGESTIVE DISEASE CONSULTANTS
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:
6
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:
1912308271
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/05/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 35629
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75235-0629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-424-2213
Provider Business Mailing Address Fax Number:
214-231-2159

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4370 MEDICAL ARTS DR
Provider Second Line Business Practice Location Address:
#295
Provider Business Practice Location Address City Name:
FLOWER MOUND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75028-1712
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-691-3777
Provider Business Practice Location Address Fax Number:
972-691-3666
Provider Enumeration Date:
09/05/2014

Additional Information

Authorized Official

Authorized Official Last Name:
SEILER
Authorized Official First Name:
MARGARET
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
214-424-2200

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP125976 , 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: 804551 . This is a "TEXAS NURSING LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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