1174158414 NPI number — MRS. SUSAN WHITE CHILDERS APRN

Table of content: MRS. SUSAN WHITE CHILDERS APRN (NPI 1174158414)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174158414 NPI number — MRS. SUSAN WHITE CHILDERS APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHILDERS
Provider First Name:
SUSAN
Provider Middle Name:
WHITE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ORTIZ
Provider Other First Name:
SUSAN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
APRN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1174158414
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3101 GARRETT DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PERRYTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79070
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-435-3606
Provider Business Mailing Address Fax Number:
806-435-2813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
OCHILTREE GENERAL HOSPITAL DISTRICT
Provider Second Line Business Practice Location Address:
3101 GARRETT DR
Provider Business Practice Location Address City Name:
PERRYTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79070
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-648-9355
Provider Business Practice Location Address Fax Number:
806-228-7071
Provider Enumeration Date:
03/06/2020

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: 363LF0000X , with the licence number:  AP145386 , 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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