1154452431 NPI number — CITY OF WILLS POINT

Table of content: (NPI 1154452431)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154452431 NPI number — CITY OF WILLS POINT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF WILLS POINT
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:
1154452431
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 700847
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75370-0847
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-250-2023
Provider Business Mailing Address Fax Number:
972-250-2086

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
120 N 5TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WILLS POINT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-873-2578
Provider Business Practice Location Address Fax Number:
903-873-5512
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
OLDACE
Authorized Official First Name:
CARLA
Authorized Official Middle Name:
T
Authorized Official Title or Position:
CITY SECRETARY
Authorized Official Telephone Number:
903-873-2578

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  234018 , 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: 506924 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com