1003169889 NPI number — MEDHEALTH

Table of content: (NPI 1003169889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003169889 NPI number — MEDHEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDHEALTH
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:
1003169889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/29/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3400 W WHEATLAND RD
Provider Second Line Business Mailing Address:
PAV III STE#360
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75237-4418
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-884-4700
Provider Business Mailing Address Fax Number:
214-884-4749

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
341 WHEATFIELD DR
Provider Second Line Business Practice Location Address:
STE#100
Provider Business Practice Location Address City Name:
SUNNYVALE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75182-4638
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-948-2076
Provider Business Practice Location Address Fax Number:
214-948-9990
Provider Enumeration Date:
10/18/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KIRBY
Authorized Official First Name:
TIM
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-947-4620

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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