1134455256 NPI number — RICHARD A NICHOLS, DPM, PA

Table of content: (NPI 1134455256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134455256 NPI number — RICHARD A NICHOLS, DPM, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
RICHARD A NICHOLS, DPM, PA
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:
1134455256
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 LANCASTER DR
Provider Second Line Business Mailing Address:
SUITE 102
Provider Business Mailing Address City Name:
GRAPEVINE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76051-3579
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-481-4000
Provider Business Mailing Address Fax Number:
817-421-0732

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1141 KELLER PKWY
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
KELLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76248-1627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-741-4800
Provider Business Practice Location Address Fax Number:
817-741-4840
Provider Enumeration Date:
10/23/2009

Additional Information

Authorized Official

Authorized Official Last Name:
NICHOLS
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PODIATRIST
Authorized Official Telephone Number:
81748140000

Provider Taxonomy Codes

  • Taxonomy code: 213EP1101X , with the licence number:  917 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0000X , with the licence number: 917 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213ES0103X , with the licence number: 917 , 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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