1972651313 NPI number — KAREN MICHELLE BARTON-NIELSEN MD

Table of content: DR. JASON WILLIAM LANG D.D.S., M.S. (NPI 1831398502)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972651313 NPI number — KAREN MICHELLE BARTON-NIELSEN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BARTON-NIELSEN
Provider First Name:
KAREN
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1972651313
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/08/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 846098
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:
75284-6098
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-324-6450
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
601 HWY 110 N BAY 0
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WHITEHOUSE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75791-3037
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-839-2585
Provider Business Practice Location Address Fax Number:
903-839-3165
Provider Enumeration Date:
01/08/2007

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:  H6034 , 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: 047364704 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 047364702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: TIN PLUS 001 . This is a "TRICARE CANTON LOCATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8BC403 . This is a "BCBS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TIN PLUS 023 . This is a "TRICARE WHITHOUSE LOCATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TIN PLUS 028 . This is a "TRICARE LINDALE LOCATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TIN PLUS 042 . This is a "TRICARE WOUND CARE LOCATION" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8B9735 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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