1396961769 NPI number — ERIN H. POWELL R.PH.T.

Table of content: SHANNON RAMIREZ LVN (NPI 1225400690)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396961769 NPI number — ERIN H. POWELL R.PH.T.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
POWELL
Provider First Name:
ERIN
Provider Middle Name:
H.
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
R.PH.T.
Provider Gender Code:
F

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:
1396961769
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/18/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
216 N EDGEFIELD RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAXAHACHIE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75165-4154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-561-8559
Provider Business Mailing Address Fax Number:
214-463-5121

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3409 WORTH ST
Provider Second Line Business Practice Location Address:
STE 725
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75246-2029
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-276-5621
Provider Business Practice Location Address Fax Number:
214-887-0496
Provider Enumeration Date:
04/17/2007

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: 183700000X , with the licence number:  123307 , 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: 221506013946032 . This is a "NATIONAL C.PH.T. CERTIFICATION" identifier . This identifiers is of the category "OTHER".
  • Identifier: 123307 . This is a "R.PH.T. LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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