1932100633 NPI number — KAREN SUE BIRDY D.O.

Table of content: KAREN SUE BIRDY D.O. (NPI 1932100633)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932100633 NPI number — KAREN SUE BIRDY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRDY
Provider First Name:
KAREN
Provider Middle Name:
SUE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1932100633
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/21/2006
NPI Reactivation Date:
04/05/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 126409
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BENBROOK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76126-0409
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-737-3331
Provider Business Mailing Address Fax Number:
817-737-2333

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9239 VISTA WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BENBROOK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76126-2451
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-737-3331
Provider Business Practice Location Address Fax Number:
817-737-2333
Provider Enumeration Date:
08/03/2005

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: 207Q00000X , with the licence number:  K7663 , 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: 0026RE . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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