1528504065 NPI number — NSMD MEDICAL PLLC

Table of content: (NPI 1528504065)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528504065 NPI number — NSMD MEDICAL PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NSMD MEDICAL PLLC
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:
VITAL CARE FAMILY PRACTICE
Provider Other Organization Name Type Code:
5
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:
1528504065
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 4467
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MIDLAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79704-4467
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-704-5663
Provider Business Mailing Address Fax Number:
432-704-5660

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4400 N MIDLAND DR
Provider Second Line Business Practice Location Address:
406B
Provider Business Practice Location Address City Name:
MIDLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79707-3385
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-704-5663
Provider Business Practice Location Address Fax Number:
432-704-5660
Provider Enumeration Date:
01/09/2017

Additional Information

Authorized Official

Authorized Official Last Name:
WYNNE
Authorized Official First Name:
CANDACE
Authorized Official Middle Name:
D
Authorized Official Title or Position:
BILLING
Authorized Official Telephone Number:
432-704-5663

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  AP121037 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: AP128857 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X , with the licence number: Q7356 , 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: 1144696436 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1417224403 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1811334105 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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