1528229192 NPI number — VCPHCS III, LP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528229192 NPI number — VCPHCS III, LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VCPHCS III, LP
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:
6
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:
1528229192
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5950 SHERRY LN
Provider Second Line Business Mailing Address:
SUITE 750
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75225-6533
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-346-3821
Provider Business Mailing Address Fax Number:
214-346-3808

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1615 KEMP BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA FALLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76309-2265
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-322-3955
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/17/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DRAUDT
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
F
Authorized Official Title or Position:
COO & PRESIDENT
Authorized Official Telephone Number:
214-346-3821

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  TX10218M , 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)