1336336957 NPI number — MRS. MICHELLE FARRAR SPRINGFIELD MICHELLE SPRINGFIELD

Table of content: MRS. MICHELLE FARRAR SPRINGFIELD MICHELLE SPRINGFIELD (NPI 1336336957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336336957 NPI number — MRS. MICHELLE FARRAR SPRINGFIELD MICHELLE SPRINGFIELD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SPRINGFIELD
Provider First Name:
MICHELLE
Provider Middle Name:
FARRAR
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MICHELLE SPRINGFIELD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
FARRAR
Provider Other First Name:
MICHELLE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
L.M.T.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1336336957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/27/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3300 OCALA CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75025-3647
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-395-6472
Provider Business Mailing Address Fax Number:
972-618-4234

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6150 INDEPENDENCE PKWY
Provider Second Line Business Practice Location Address:
SUITE K
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75023-4000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-395-6472
Provider Business Practice Location Address Fax Number:
972-618-4234
Provider Enumeration Date:
09/27/2007

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: 174400000X , with the licence number:  MT045736 , 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)





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