1235288481 NPI number — KATHY A. TOLER, MD, PA

Table of content: (NPI 1235288481)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235288481 NPI number — KATHY A. TOLER, MD, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KATHY A. TOLER, MD, 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:
1235288481
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 885
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ADDISON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75001-0885
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-991-9950
Provider Business Mailing Address Fax Number:
972-991-4026

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 MEDICAL PKWY
Provider Second Line Business Practice Location Address:
PLAZA 3, STE. 201
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75234-7840
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-488-8441
Provider Business Practice Location Address Fax Number:
972-488-8489
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TOLER
Authorized Official First Name:
KATHY
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MEDICAL DOCTOR
Authorized Official Telephone Number:
972-488-8441

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  H4054 , 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: 0098QV . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 162294601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DH2201 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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