1265562805 NPI number — BOYCE INTERPRISES INC

Table of content: MS. JANETTE LYNN PENNINGTON CSWA (NPI 1326570532)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265562805 NPI number — BOYCE INTERPRISES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOYCE INTERPRISES INC
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:
1265562805
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/07/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1619 N HAMPTON RD
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
DESOTO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75115-2303
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-224-7787
Provider Business Mailing Address Fax Number:
972-298-0462

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1619 N HAMPTON RD
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
DESOTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75115-2303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-224-7787
Provider Business Practice Location Address Fax Number:
972-298-0462
Provider Enumeration Date:
03/06/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOYCE
Authorized Official First Name:
MERLE
Authorized Official Middle Name:
H
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
972-224-7787

Provider Taxonomy Codes

  • Taxonomy code: 311Z00000X , with the licence number:  008779 , 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)