1265592877 NPI number — OSCAR F FIMBRES CRNA

Table of content: OSCAR F FIMBRES CRNA (NPI 1265592877)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265592877 NPI number — OSCAR F FIMBRES CRNA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FIMBRES
Provider First Name:
OSCAR
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNA
Provider Gender Code:
M

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:
1265592877
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 99371
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76199-0371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-885-1855
Provider Business Mailing Address Fax Number:
682-885-7347

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 7TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-2733
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-885-4054
Provider Business Practice Location Address Fax Number:
682-885-7497
Provider Enumeration Date:
12/12/2006

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: 367500000X , with the licence number:  451513 , 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: 10033788 . This is a "AMERIGROUP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 109806307 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1447220850 . This is a "GRP NPI NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1900008 . This is a "UHC PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 109806308 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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