1043455660 NPI number — UNITED MEDCARE, INC

Table of content: (NPI 1043455660)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1043455660 NPI number — UNITED MEDCARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED MEDCARE, INC
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:
1043455660
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 226463
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75222-6463
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-631-6611
Provider Business Mailing Address Fax Number:
214-631-6612

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8204 ELMBROOK DR
Provider Second Line Business Practice Location Address:
STE 370
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75247-4067
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-631-6611
Provider Business Practice Location Address Fax Number:
214-631-6612
Provider Enumeration Date:
12/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
EKUKPE
Authorized Official First Name:
JOE
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
214-631-6611

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  1000204 , 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: 1000204 . This is a "DSHS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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