1457428906 NPI number — SOUTHWEST LTC - MEADOW VIEW, LTD

Table of content: (NPI 1457428906)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457428906 NPI number — SOUTHWEST LTC - MEADOW VIEW, LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST LTC - MEADOW VIEW, LTD
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:
1457428906
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/06/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5560 TENNYSON PKWY STE 210
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75024-3582
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-916-6100
Provider Business Mailing Address Fax Number:
469-916-6105

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2815 MEDLIN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76015-2329
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-465-9596
Provider Business Practice Location Address Fax Number:
817-465-4026
Provider Enumeration Date:
11/29/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PAYNE
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGER
Authorized Official Telephone Number:
469-916-6100

Provider Taxonomy Codes

  • Taxonomy code: 310400000X , with the licence number:  000847 , 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: 001014524 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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