1497031413 NPI number — CENTRAL PARK EAR NOSE AND THROAT LLP DALLAS

Table of content: (NPI 1497031413)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497031413 NPI number — CENTRAL PARK EAR NOSE AND THROAT LLP DALLAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL PARK EAR NOSE AND THROAT LLP DALLAS
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:
1497031413
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/15/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 CENTRAL PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76014-2069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-261-9191
Provider Business Mailing Address Fax Number:
817-784-6880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3131 TURTLE CREEK BLVD
Provider Second Line Business Practice Location Address:
SUITE 302
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75219-5405
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-884-5606
Provider Business Practice Location Address Fax Number:
972-884-5607
Provider Enumeration Date:
10/24/2011

Additional Information

Authorized Official

Authorized Official Last Name:
BERMINGHAM
Authorized Official First Name:
GRACE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATIVE SERVICES MANAGER
Authorized Official Telephone Number:
817-261-9191

Provider Taxonomy Codes

  • Taxonomy code: 207Y00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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