1407849961 NPI number — UROLOGY ASSOCIATES OF NORTH TEXAS LLP

Table of content: (NPI 1407849961)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407849961 NPI number — UROLOGY ASSOCIATES OF NORTH TEXAS LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UROLOGY ASSOCIATES OF NORTH TEXAS LLP
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:
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Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1407849961
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 120549
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76012-0549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-303-4521
Provider Business Mailing Address Fax Number:
817-468-5876

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
925 SANTA FE DR
Provider Second Line Business Practice Location Address:
SUITE 114
Provider Business Practice Location Address City Name:
WEATHERFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76086-5866
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-303-4521
Provider Business Practice Location Address Fax Number:
817-468-5876
Provider Enumeration Date:
08/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WILSON
Authorized Official First Name:
THERESA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
CENTRAL BILLING OFFICE MANAGER
Authorized Official Telephone Number:
817-543-4909

Provider Taxonomy Codes

  • Taxonomy code: 208800000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 109535802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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