1467473165 NPI number — CITY OF ADDISON

Table of content: (NPI 1467473165)

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:
06/26/2008
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:
ROLLER
Authorized Official First Name:
KATIE
Authorized Official Middle Name:
Authorized Official Title or Position:
FINANCIAL SUPERVISOR
Authorized Official Telephone Number:
972-450-7091

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: AMB833 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 590007397 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".