1457366304 NPI number — CITY OF CORINTH

Table of content: (NPI 1457366304)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457366304 NPI number — CITY OF CORINTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF CORINTH
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:
1457366304
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3501 FM 2181
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
CORINTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76210-2634
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-279-4590
Provider Business Mailing Address Fax Number:
940-279-4599

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3501 FM 2181
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
CORINTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76210-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-279-4590
Provider Business Practice Location Address Fax Number:
940-279-4599
Provider Enumeration Date:
07/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
LUTHER
Authorized Official First Name:
ADAM
Authorized Official Middle Name:
Authorized Official Title or Position:
DIVISION CHIEF
Authorized Official Telephone Number:
940-279-4590

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  1000134 , 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: AMB556 . This is a "BC/BS OF TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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