1063411759 NPI number — ESSENT PRMC LP

Table of content: (NPI 1063411759)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063411759 NPI number — ESSENT PRMC LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ESSENT PRMC LP
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:
1063411759
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9070
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PARIS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75461-9070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-737-3257
Provider Business Mailing Address Fax Number:
903-737-3375

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
447 5TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HONEY GROVE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75446-1427
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-378-3252
Provider Business Practice Location Address Fax Number:
903-378-3426
Provider Enumeration Date:
07/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
BROWDER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
615-312-5103

Provider Taxonomy Codes

  • Taxonomy code: 261QR1300X , 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: 165400602 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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