1992910731 NPI number — TED MCLEMORE, M.D., PH.D. P A

Table of content: (NPI 1992910731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992910731 NPI number — TED MCLEMORE, M.D., PH.D. P A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TED MCLEMORE, M.D., PH.D. P A
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:
6
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:
1992910731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/01/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1055 CLARKSVILLE ST
Provider Second Line Business Mailing Address:
110
Provider Business Mailing Address City Name:
PARIS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75460-6097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-784-7472
Provider Business Mailing Address Fax Number:
903-784-4598

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1055 CLARKSVILLE ST
Provider Second Line Business Practice Location Address:
110
Provider Business Practice Location Address City Name:
PARIS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75460-6097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-784-7472
Provider Business Practice Location Address Fax Number:
903-784-4598
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MCLEMORE
Authorized Official First Name:
TED
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
903-784-7472

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  F9806 , 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: 080468401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00373N . This is a "BLUE CROSS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100754820A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: CG4924 . This is a "MCR RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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