1508067760 NPI number — DR. KATRINA PAULINE BIRDWELL M.D.

Table of content: DR. KATRINA PAULINE BIRDWELL M.D. (NPI 1508067760)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508067760 NPI number — DR. KATRINA PAULINE BIRDWELL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BIRDWELL
Provider First Name:
KATRINA
Provider Middle Name:
PAULINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
EMMETT
Provider Other First Name:
KATRINA
Provider Other Middle Name:
PAULINE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1508067760
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/19/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 911230
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:
75391-1230
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-997-8000
Provider Business Mailing Address Fax Number:
972-234-0813

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
221 W COLORADO BLVD
Provider Second Line Business Practice Location Address:
PAV II, SUITE 532
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75208-2363
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-943-8605
Provider Business Practice Location Address Fax Number:
214-946-8339
Provider Enumeration Date:
05/29/2007

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: 208600000X , with the licence number:  P0580 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086X0206X , with the licence number: P0580 , 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: 306166505 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 306166504 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 306166506 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com