1275013955 NPI number — CHILDREN'S HEALTH PM URGENT CARE, PLLC

Table of content: (NPI 1275013955)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275013955 NPI number — CHILDREN'S HEALTH PM URGENT CARE, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDREN'S HEALTH PM URGENT CARE, PLLC
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:
1275013955
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 HOLLOW LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW HYDE PARK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
11042-1220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
516-869-0650
Provider Business Mailing Address Fax Number:
516-673-9408

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5151 HWY 121
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
THE COLONY
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75056-2601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-488-5437
Provider Business Practice Location Address Fax Number:
214-488-5438
Provider Enumeration Date:
08/21/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SIMPSON
Authorized Official First Name:
MARLENA
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. DIRECTOR, CRED & ENROLLMENT
Authorized Official Telephone Number:
516-207-7851

Provider Taxonomy Codes

  • Taxonomy code: 2080P0204X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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