1285608281 NPI number — DR. JOSEPH F MCNALLY JR. MD

Table of content: DR. JOSEPH F MCNALLY JR. MD (NPI 1285608281)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285608281 NPI number — DR. JOSEPH F MCNALLY JR. MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MCNALLY
Provider First Name:
JOSEPH
Provider Middle Name:
F
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
MD
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:
1285608281
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 HOSPITAL DR
Provider Second Line Business Mailing Address:
SUITE 120
Provider Business Mailing Address City Name:
CORSICANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75110-2415
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-872-3005
Provider Business Mailing Address Fax Number:
903-872-3050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 HOSPITAL DR
Provider Second Line Business Practice Location Address:
SUITE 140
Provider Business Practice Location Address City Name:
CORSICANA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75110-2471
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-872-3005
Provider Business Practice Location Address Fax Number:
903-654-4628
Provider Enumeration Date:
02/15/2006

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: 207RA0201X , with the licence number:  E2721 , 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: 120524706 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DG9311 . This is a "RAILROAD MEDICARE GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00463093 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00Y226 . This is a "MEDICARE GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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