1952330912 NPI number — RANDALLS FOOD & DRUGS LP

Table of content: LESLIE DIANE TURNER APRN (NPI 1518737436)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952330912 NPI number — RANDALLS FOOD & DRUGS LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RANDALLS FOOD & DRUGS LP
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:
1952330912
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/05/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
250 E PARKCENTER BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOISE
Provider Business Mailing Address State Name:
ID
Provider Business Mailing Address Postal Code:
83706-3940
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9911 BRODIE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78748-5802
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-280-1201
Provider Business Practice Location Address Fax Number:
512-282-2759
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GIANNAKOPOULOS
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
Authorized Official Title or Position:
ENROLLMENTS MANAGER
Authorized Official Telephone Number:
208-395-3954

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 333600000X , with the licence number: 22234 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 3336C0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 465329 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 4525993 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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