1528011814 NPI number — PHYSICIANS AND ALLIED HEALTH PROFESSIONALS GROUP, PA

Table of content: (NPI 1528011814)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528011814 NPI number — PHYSICIANS AND ALLIED HEALTH PROFESSIONALS GROUP, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PHYSICIANS AND ALLIED HEALTH PROFESSIONALS GROUP, PA
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:
1528011814
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12700 PARK CENTRAL DR
Provider Second Line Business Mailing Address:
STE 900
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75251-1500
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-860-6053
Provider Business Mailing Address Fax Number:
469-854-0738

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12700 PARK CENTRAL DR
Provider Second Line Business Practice Location Address:
STE 900
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75251-1500
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-860-6053
Provider Business Practice Location Address Fax Number:
469-854-0738
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
HEIGHTEN
Authorized Official First Name:
CLAY
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
972-739-3001

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RH0003X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207W00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207X00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208100000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 0046AZ . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 200016270A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109379103 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 109379104 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 79506232 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".




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