1518108067 NPI number — LAUREN DOUGLAS PA

Table of content: LAUREN DOUGLAS PA (NPI 1518108067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1518108067 NPI number — LAUREN DOUGLAS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOUGLAS
Provider First Name:
LAUREN
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA
Provider Gender Code:
F

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:
1518108067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 844658
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:
75284-4658
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-248-8800
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 SCOTT AND WHITE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLLEGE STATION
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77845-6440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
979-207-4000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2009

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: 363A00000X , 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: 2872434-01 . This is a "FQHC FACILITY TPI (HEARNE CHC)" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1558645333 . This is a "NPI-HEARNE CHC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1821185299 . This is a "FQHC-BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC. - AGENCY NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 74-1715140 . This is a "BRAZOS VALLEY COMMUNITY ACTION AGENCY, INC." identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".