1205901279 NPI number — MS. CLAUDIA W BULLARD LPT

Table of content: MS. CLAUDIA W BULLARD LPT (NPI 1205901279)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205901279 NPI number — MS. CLAUDIA W BULLARD LPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BULLARD
Provider First Name:
CLAUDIA
Provider Middle Name:
W
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LPT
Provider Gender Code:
F

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:
1205901279
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/23/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1233
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KINGSVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78364-1233
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-358-9200
Provider Business Mailing Address Fax Number:
361-362-1671

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1602 E HOUSTON ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BEEVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78102-5326
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-358-9200
Provider Business Practice Location Address Fax Number:
361-362-1671
Provider Enumeration Date:
11/22/2006

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: 2251X0800X , with the licence number:  1132348 , 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: 166806301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 84485T . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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