1982225710 NPI number — CARPE DIEM PRIMARY CARE

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 1982225710 NPI number — CARPE DIEM PRIMARY CARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARPE DIEM PRIMARY CARE
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:
1982225710
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/04/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3408
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PFLUGERVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78691-3408
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-677-6166
Provider Business Mailing Address Fax Number:
512-807-0663

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
201 HEATHERWILDE BLVD
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
PFLUGERVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78660
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-677-6166
Provider Business Practice Location Address Fax Number:
512-807-0663
Provider Enumeration Date:
05/04/2020

Additional Information

Authorized Official

Authorized Official Last Name:
MAYO
Authorized Official First Name:
TAMIKA
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
225-266-5036

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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