1306933098 NPI number — COMPREHENSIVE BREAST CARE CENTER OF TEXAS INC

Table of content: (NPI 1306933098)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306933098 NPI number — COMPREHENSIVE BREAST CARE CENTER OF TEXAS INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE BREAST CARE CENTER OF TEXAS INC
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:
6
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:
1306933098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/09/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 CONGRESS AVE
Provider Second Line Business Mailing Address:
SUITE 2150
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78701-2991
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-370-8100
Provider Business Mailing Address Fax Number:
512-370-8198

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-7305
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-924-1999
Provider Business Practice Location Address Fax Number:
817-886-0881
Provider Enumeration Date:
10/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
KANEWSKE
Authorized Official First Name:
EILEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
512-370-8114

Provider Taxonomy Codes

  • Taxonomy code: 2085R0202X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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