1982803458 NPI number — DR. ARUN K PADALA MD

Table of content: DR. ARUN K PADALA MD (NPI 1982803458)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982803458 NPI number — DR. ARUN K PADALA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PADALA
Provider First Name:
ARUN
Provider Middle Name:
K
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1982803458
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/26/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1900 MISTLETOE BLVD
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76104-4050
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-338-1300
Provider Business Mailing Address Fax Number:
817-335-9871

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12500 DALLAS PKWY STE 4.600
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75033-4231
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-495-9001
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/16/2007

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: 207RI0011X , with the licence number:  P8967 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X , with the licence number: P8967 , 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: 357112YT79 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 207RI0011X . This is a "TAXONOMY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 338428103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 357112ZHL4 . This is a "MEDICARE PTAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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