1457358038 NPI number — CHEST DIAGNOSTIC THERAPEUTIC SVCS & TRANSIT NURSING OF TX, INC

Table of content: (NPI 1457358038)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457358038 NPI number — CHEST DIAGNOSTIC THERAPEUTIC SVCS & TRANSIT NURSING OF TX, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHEST DIAGNOSTIC THERAPEUTIC SVCS & TRANSIT NURSING OF TX, INC
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:
1457358038
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/16/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 289
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEXIA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76667-0289
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-562-3803
Provider Business Mailing Address Fax Number:
254-562-2372

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
903 S BECKHAM AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TYLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75701-1907
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-596-9565
Provider Business Practice Location Address Fax Number:
903-592-0114
Provider Enumeration Date:
06/28/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WRAGGE
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
H
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
254-562-3803

Provider Taxonomy Codes

  • Taxonomy code: 332BX2000X , with the licence number:  0085076 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 332B00000X , with the licence number: 0085076 , 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: 153611204 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 102817100 . This is a "FIRSTCARE PROV NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 153611203 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 156350XX . This is a "PREFERRED CARE PROV NUMBE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com