1174631790 NPI number — NORTH TEXAS CLINIC & REHABILITATION CENTER, P.A.

Table of content: SABRINA MARLOWE GERSTER FNP (NPI 1093230435)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174631790 NPI number — NORTH TEXAS CLINIC & REHABILITATION CENTER, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH TEXAS CLINIC & REHABILITATION CENTER, P.A.
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:
1174631790
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 48100
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WATAUGA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76148-0100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-581-5959
Provider Business Mailing Address Fax Number:
817-581-9231

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5750 RUFE SNOW DR
Provider Second Line Business Practice Location Address:
STE 100
Provider Business Practice Location Address City Name:
NORTH RICHLAND HILLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76180-6163
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-581-5959
Provider Business Practice Location Address Fax Number:
817-581-9231
Provider Enumeration Date:
08/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BROZEK
Authorized Official First Name:
VAUGHN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
PRESIDENT CHIROPRACTOR
Authorized Official Telephone Number:
817-581-5959

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  6838 , 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: 44KG . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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