1215156062 NPI number — HAMILTON-LUCAS PHYSICIANS PA

Table of content: (NPI 1215156062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215156062 NPI number — HAMILTON-LUCAS PHYSICIANS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAMILTON-LUCAS PHYSICIANS PA
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:
1215156062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/30/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 N HAMPTON RD
Provider Second Line Business Mailing Address:
STE 315
Provider Business Mailing Address City Name:
DESOTO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75115-2391
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-709-1961
Provider Business Mailing Address Fax Number:
972-283-1681

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 N HAMPTON RD
Provider Second Line Business Practice Location Address:
STE 315
Provider Business Practice Location Address City Name:
DESOTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75115-2391
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-709-1961
Provider Business Practice Location Address Fax Number:
972-283-1681
Provider Enumeration Date:
04/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HAMILTON
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
G
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-709-1961

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  H7459 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2084P0800X , with the licence number: G7407 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 86X590 . This is a "BLUE CROSS DR. LUCAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 084786501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 86X591 . This is a "BLUE CROSS DR HAMILTON" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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