1467473165 NPI number — CITY OF ADDISON

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1467473165 NPI number — CITY OF ADDISON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF ADDISON
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:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1467473165
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 180819
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75218
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-450-7090
Provider Business Mailing Address Fax Number:
972-450-7096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4798 AIRPORT PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ADDISON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75001-3364
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-450-7201
Provider Business Practice Location Address Fax Number:
972-450-7208
Provider Enumeration Date:
07/21/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ALEXANDER
Authorized Official First Name:
CHRISTOFER
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT CHIEF
Authorized Official Telephone Number:
972-450-7203

Provider Taxonomy Codes

  • Taxonomy code: 3416L0300X , with the licence number:  504181 , 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: 000021801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 590007397 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: AMB833 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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