1033281241 NPI number — ERNEST A TEEGARDEN D.O.

Table of content: ERNEST A TEEGARDEN D.O. (NPI 1033281241)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033281241 NPI number — ERNEST A TEEGARDEN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TEEGARDEN
Provider First Name:
ERNEST
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1033281241
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/21/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7300 REMCON CIR
Provider Second Line Business Mailing Address:
STE 200
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79912-1642
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-532-3600
Provider Business Mailing Address Fax Number:
915-532-8999

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7300 REMCON CIR
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79912-1642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-532-3600
Provider Business Practice Location Address Fax Number:
915-532-8999
Provider Enumeration Date:
11/14/2006

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: 207LP2900X , with the licence number:  E3127 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207L00000X , with the licence number: E3127 , 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: P01696897 . This is a "RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 133035902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 133035911 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8FX659 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 133035912 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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