1407195795 NPI number — CARESPOT PROFESSIONAL SERVICES OF TEXAS, P.A.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407195795 NPI number — CARESPOT PROFESSIONAL SERVICES OF TEXAS, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARESPOT PROFESSIONAL SERVICES OF TEXAS, P.A.
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:
1407195795
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
115 EASTPARK DR
Provider Second Line Business Mailing Address:
SUITE 300
Provider Business Mailing Address City Name:
BRENTWOOD
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37027-7548
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
615-600-4075
Provider Business Mailing Address Fax Number:
615-309-4624

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3750 GATTIS SCHOOL RD
Provider Second Line Business Practice Location Address:
SUITE 900
Provider Business Practice Location Address City Name:
ROUND ROCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78664-4642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-501-6576
Provider Business Practice Location Address Fax Number:
512-341-9162
Provider Enumeration Date:
02/06/2013

Additional Information

Authorized Official

Authorized Official Last Name:
MEKO
Authorized Official First Name:
JENNIFER
Authorized Official Middle Name:
B
Authorized Official Title or Position:
SOLE OFFICER
Authorized Official Telephone Number:
615-260-7921

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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