1962741462 NPI number — TFI FAMILY CONNECTIONS LLC

Table of content: (NPI 1962741462)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962741462 NPI number — TFI FAMILY CONNECTIONS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TFI FAMILY CONNECTIONS LLC
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:
1962741462
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/09/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2224
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EMPORIA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66801-2224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
620-343-6111
Provider Business Mailing Address Fax Number:
785-232-2833

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5204 JACQUELYN LN
Provider Second Line Business Practice Location Address:
STE 15
Provider Business Practice Location Address City Name:
BARTLESVILLE
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74006-7733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
620-342-2239
Provider Business Practice Location Address Fax Number:
620-342-0451
Provider Enumeration Date:
02/05/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DOLD HARRIS
Authorized Official First Name:
CAROL
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
620-208-1826

Provider Taxonomy Codes

  • Taxonomy code: 104100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 253J00000X , with the licence number: K860000352 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200874980A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200874980J , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200874980G , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".