1326295460 NPI number — MRS. MEGAN COX GONZALEZ DPT

Table of content: MRS. MEGAN COX GONZALEZ DPT (NPI 1326295460)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326295460 NPI number — MRS. MEGAN COX GONZALEZ DPT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GONZALEZ
Provider First Name:
MEGAN
Provider Middle Name:
COX
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
DPT
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COX
Provider Other First Name:
MEGAN
Provider Other Middle Name:
FIELDING
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1326295460
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1701 LIBRARY BLVD SUITE A
Provider Second Line Business Mailing Address:
COLLABORATING FOR KIDS, LLC
Provider Business Mailing Address City Name:
GREENWOOD
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46142
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-840-0558
Provider Business Mailing Address Fax Number:
614-840-9310

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1701 LIBRARY BLVD
Provider Second Line Business Practice Location Address:
SUITE A
Provider Business Practice Location Address City Name:
GREENWOOD
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46142
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-881-9923
Provider Business Practice Location Address Fax Number:
614-840-9310
Provider Enumeration Date:
08/20/2008

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: 2251P0200X , with the licence number:  PT 012145 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2642626 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".




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