1487673695 NPI number — DR. HARRY J CAZZOLA MD

Table of content: DONNA KALLIO WOLBERS PA-C (NPI 1639622541)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487673695 NPI number — DR. HARRY J CAZZOLA MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CAZZOLA
Provider First Name:
HARRY
Provider Middle Name:
J
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1487673695
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3046
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MALVERN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19355-0746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-452-5522
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
301 N 23RD ST
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
CANYON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79015-3028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-452-5522
Provider Business Practice Location Address Fax Number:
806-452-3070
Provider Enumeration Date:
07/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207VG0400X , with the licence number:  G0966 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: G0966 , 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: 160046831 . This is a "RRM" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8GE512 . This is a "BCBS OF TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00FR71 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1231052-05 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1487673695 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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