1306390596 NPI number — DOCTORS FOR A BETTER TOMORROW PLLC

Table of content: (NPI 1306390596)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306390596 NPI number — DOCTORS FOR A BETTER TOMORROW PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DOCTORS FOR A BETTER TOMORROW 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:
SUPERIOR URGENT CARE
Provider Other Organization Name Type Code:
3
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:
1306390596
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1216 E KENOSHA ST
Provider Second Line Business Mailing Address:
SUITE 207
Provider Business Mailing Address City Name:
BROKEN ARROW
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
74012-2007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2122 RUFE SNOW DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KELLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76248-5691
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-900-3415
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/05/2016

Additional Information

Authorized Official

Authorized Official Last Name:
KANU
Authorized Official First Name:
TERATA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
817-900-3415

Provider Taxonomy Codes

  • 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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