1144271792 NPI number — NORTH TEXAS LUNG & SLEEP CLINIC PA

Table of content: (NPI 1144271792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144271792 NPI number — NORTH TEXAS LUNG & SLEEP CLINIC PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH TEXAS LUNG & SLEEP CLINIC 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:
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:
1144271792
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 100189
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76185-0189
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-731-0230
Provider Business Mailing Address Fax Number:
817-731-7046

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2801 S HULEN ST
Provider Second Line Business Practice Location Address:
SUITE 600
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76109-1517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-731-0230
Provider Business Practice Location Address Fax Number:
817-731-7046
Provider Enumeration Date:
05/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
OSTRANSKY
Authorized Official First Name:
DAVID
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-731-0230

Provider Taxonomy Codes

  • Taxonomy code: 207RP1001X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CH3974 . This is a "MEDICARE RR GROUP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 00724N . This is a "BCBS GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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