1962721860 NPI number — CAREMOR HEALTH SERVICES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962721860 NPI number — CAREMOR HEALTH SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAREMOR HEALTH SERVICES
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:
1962721860
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1708 N HOBART ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PAMPA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79065-4130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-665-5571
Provider Business Mailing Address Fax Number:
806-665-8986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1708 N HOBART ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PAMPA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79065-4130
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-665-5571
Provider Business Practice Location Address Fax Number:
806-665-8986
Provider Enumeration Date:
05/18/2010

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PSHIGODA
Authorized Official First Name:
LILLIE
Authorized Official Middle Name:
Authorized Official Title or Position:
CSR
Authorized Official Telephone Number:
806-665-5571

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , with the licence number:  017077101 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 108474002 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BX2000X , with the licence number: 01077110 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332BC3200X , with the licence number: 1265402077 , 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)