1184764276 NPI number — FAMILY FIRST HEALTHCARE

Table of content: (NPI 1184764276)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184764276 NPI number — FAMILY FIRST HEALTHCARE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY FIRST HEALTHCARE
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:
1184764276
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/05/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4700 W ELDORADO PKWY
Provider Second Line Business Mailing Address:
SUITE 210
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75070-5239
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-369-0744
Provider Business Mailing Address Fax Number:
972-369-0644

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4700 W ELDORADO PKWY
Provider Second Line Business Practice Location Address:
SUITE 210
Provider Business Practice Location Address City Name:
MCKINNEY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75070-5239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-369-0744
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/07/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PATE
Authorized Official First Name:
SARAH
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE ADM
Authorized Official Telephone Number:
972-369-0744

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  273121 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: E4513 , 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: 133516809 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 80166325 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DA2786 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8J1200 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 163200202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 00332V . This is a "MEDICARE GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0087JY . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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