1306819032 NPI number — BILLY B WESTBROOK D.P.M.

Table of content: BILLY B WESTBROOK D.P.M. (NPI 1306819032)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306819032 NPI number — BILLY B WESTBROOK D.P.M.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
WESTBROOK
Provider First Name:
BILLY
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.P.M.
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:
1306819032
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2828 N 4TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LONGVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75605-5718
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-758-4468
Provider Business Mailing Address Fax Number:
903-758-5056

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2828 N FOURTH ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LONGVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75605-5718
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-758-4468
Provider Business Practice Location Address Fax Number:
903-758-5056
Provider Enumeration Date:
02/13/2006

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: 213E00000X , with the licence number:  TX0578 , 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: 092751901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 480001643 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 480928621 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8AJ312 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 751523800 . This is a "IRS INDIVIDUAL TAXPAYER IDENTIFICATION NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 092751902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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