1134351190 NPI number — NICOLE WING CHEE TONG-MITCHELL D.O.

Table of content: NICOLE WING CHEE TONG-MITCHELL D.O. (NPI 1134351190)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134351190 NPI number — NICOLE WING CHEE TONG-MITCHELL D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TONG-MITCHELL
Provider First Name:
NICOLE
Provider Middle Name:
WING CHEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
TONG
Provider Other First Name:
NICOLE
Provider Other Middle Name:
WING CHEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1134351190
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/07/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
221 N KANSAS ST
Provider Second Line Business Mailing Address:
STE. 1501
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79901-1443
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
915-546-9200
Provider Business Mailing Address Fax Number:
915-546-9800

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 N KANSAS ST
Provider Second Line Business Practice Location Address:
STE. 1501
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79901-1443
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
915-546-9200
Provider Business Practice Location Address Fax Number:
915-546-9800
Provider Enumeration Date:
08/10/2009

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: 207R00000X , with the licence number:  OT013615 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X , with the licence number: 5101018207 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: P7863 , 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: 81359811 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: P01261172 . This is a "RAILROAD RETIREMENT MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 331777801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com