1093899874 NPI number — PEDIATRIC ALLERGY IMMUNOLOGY ASSOC.,P.A.

Table of content: (NPI 1093899874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093899874 NPI number — PEDIATRIC ALLERGY IMMUNOLOGY ASSOC.,P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PEDIATRIC ALLERGY IMMUNOLOGY ASSOC.,P.A.
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:
1093899874
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/28/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7777 FOREST LN
Provider Second Line Business Mailing Address:
SUITE B332
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75230-2571
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-566-7788
Provider Business Mailing Address Fax Number:
972-566-8837

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4500 HILLCREST
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75035-5418
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-377-4025
Provider Business Practice Location Address Fax Number:
972-377-4022
Provider Enumeration Date:
10/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WASSERMAN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-566-7788

Provider Taxonomy Codes

  • Taxonomy code: 207K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200032360A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 085161002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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