1457546889 NPI number — STRONG HEALTHCARE, INC

Table of content: (NPI 1457546889)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457546889 NPI number — STRONG HEALTHCARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STRONG HEALTHCARE, 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:
1457546889
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/24/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
420 N COIT RD
Provider Second Line Business Mailing Address:
STE 2016
Provider Business Mailing Address City Name:
RICHARDSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75080-5447
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-664-1616
Provider Business Mailing Address Fax Number:
972-664-1615

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
420 N COIT RD
Provider Second Line Business Practice Location Address:
STE 2016
Provider Business Practice Location Address City Name:
RICHARDSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75080-5447
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-664-1616
Provider Business Practice Location Address Fax Number:
972-664-1615
Provider Enumeration Date:
09/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
STRONG
Authorized Official First Name:
MARTHA
Authorized Official Middle Name:
Authorized Official Title or Position:
PEDIATRIC NURSE PRACTITIONER/OWNER
Authorized Official Telephone Number:
972-664-1616

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  625371 , 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: 138973617 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 388273002 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 138973618 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 388273003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 388273001 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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