1023612777 NPI number — HEALTHIER WAY FAMILY CARE PLLC

Table of content: (NPI 1023612777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023612777 NPI number — HEALTHIER WAY FAMILY CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHIER WAY FAMILY CARE PLLC
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:
1023612777
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 US HIGHWAY 259 N
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ORE CITY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75683-5763
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-968-2847
Provider Business Mailing Address Fax Number:
903-968-8958

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 US HIGHWAY 259 N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ORE CITY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75683-5763
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-968-2847
Provider Business Practice Location Address Fax Number:
903-968-8958
Provider Enumeration Date:
11/24/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PERRY
Authorized Official First Name:
MANDY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
903-968-2847

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1694561564 . This is a "AMERIGROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 9363417 . This is a "CIGNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: H000RJ8101 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 431976602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 431976602 . This is a "MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: EB1820 . This is a "RAILROAD PALMETTO" identifier . This identifiers is of the category "OTHER".