1063571552 NPI number — BUCKNER RETIREMENT SERVICES, INC

Table of content: (NPI 1063571552)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063571552 NPI number — BUCKNER RETIREMENT SERVICES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BUCKNER RETIREMENT SERVICES, 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:
1063571552
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 N PEARL ST
Provider Second Line Business Mailing Address:
SUITE 1200
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75201-2824
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-758-8000
Provider Business Mailing Address Fax Number:
214-758-8153

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2201 HORSESHOE LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75605-5650
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-234-0000
Provider Business Practice Location Address Fax Number:
903-757-8949
Provider Enumeration Date:
12/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
G.
Authorized Official Title or Position:
SENIOR VICE PRESIDENT
Authorized Official Telephone Number:
214-758-8031

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  103186 , 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)





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