1306893128 NPI number — QUESTCARE MEDICAL SERVICES PLLC

Table of content: (NPI 1306893128)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306893128 NPI number — QUESTCARE MEDICAL SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
QUESTCARE MEDICAL SERVICES 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:
1306893128
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13737 NOEL RD
Provider Second Line Business Mailing Address:
#1600
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75240-1331
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
954-838-2371
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12221 MERIT DR
Provider Second Line Business Practice Location Address:
SUITE 1610
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75251-2202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-401-2386
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KONDAS
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICER
Authorized Official Telephone Number:
954-838-2371

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 119838402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: CD6603 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0088BH . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: CD6602 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0023BM . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0087BH . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 119838405 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: CD4261 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DD9969 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: CD6604 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 119838403 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119838401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 119838406 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 34357203 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: CD4260 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: CD6600 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: CD4262 . This is a "MEDICARE RR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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