1366559981 NPI number — ADDISON FOOT CENTER

Table of content: (NPI 1366559981)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366559981 NPI number — ADDISON FOOT CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADDISON FOOT CENTER
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:
1366559981
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/28/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5000 BELTLINE RD
Provider Second Line Business Mailing Address:
SUITE 900
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75254
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-239-4398
Provider Business Mailing Address Fax Number:
972-239-4329

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5000 BELT LINE RD
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75254-6789
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-239-4398
Provider Business Practice Location Address Fax Number:
972-239-4329
Provider Enumeration Date:
08/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FOX
Authorized Official First Name:
PAT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
972-239-4398

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  0562 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 213E00000X , with the licence number: 0588 , 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: 886223 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1124299672 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1760492839 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 886222 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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