1336443621 NPI number — PRABHA MOHAN MD PA

Table of content: (NPI 1336443621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336443621 NPI number — PRABHA MOHAN MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRABHA MOHAN MD PA
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:
1336443621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/01/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
709 ED HALL DR
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
KAUFMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75142-1860
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-932-2000
Provider Business Mailing Address Fax Number:
972-932-0316

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
709 ED HALL DR
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
KAUFMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75142-1860
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-932-2000
Provider Business Practice Location Address Fax Number:
972-932-0316
Provider Enumeration Date:
01/01/2011

Additional Information

Authorized Official

Authorized Official Last Name:
MOHAN
Authorized Official First Name:
RICH
Authorized Official Middle Name:
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
469-569-7140

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  K1567 , 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: 029765701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com