1215230487 NPI number — TRI-CORD HEALTH, LLC

Table of content: (NPI 1215230487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215230487 NPI number — TRI-CORD HEALTH, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI-CORD HEALTH, LLC
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:
1215230487
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 MANN ST
Provider Second Line Business Mailing Address:
SUITE #702
Provider Business Mailing Address City Name:
CORPUS CHRISTI
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78401-2046
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
361-561-6266
Provider Business Mailing Address Fax Number:
361-561-6269

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 MANN ST
Provider Second Line Business Practice Location Address:
SUITE #702
Provider Business Practice Location Address City Name:
CORPUS CHRISTI
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78401-2046
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
361-561-6266
Provider Business Practice Location Address Fax Number:
361-561-6269
Provider Enumeration Date:
12/10/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SEAY
Authorized Official First Name:
MICHELE
Authorized Official Middle Name:
ELIZABETH
Authorized Official Title or Position:
ADMINISTRATOR/DON
Authorized Official Telephone Number:
361-633-7879

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 013891 . This is a "HCSS AGENCY LICENSE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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