1538120969 NPI number — AJAY TRIPURANENI MD

Table of content: AJAY TRIPURANENI MD (NPI 1538120969)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538120969 NPI number — AJAY TRIPURANENI MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TRIPURANENI
Provider First Name:
AJAY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1538120969
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/23/2022
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:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2401 S 31ST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76508-2316
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-724-2111
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2006

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: 207RC0000X , with the licence number:  MD24630 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: MD24630 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: MD60671202 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RC0001X , with the licence number: T6399 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RC0000X , with the licence number: MD60671202 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: MD24630 , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 838334001 . This is a "BCBS-ROSEBURG" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 858464003 . This is a "BCBS-SPRINGFIELD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: P00172920 . This is a "RR MEDICARE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 838366006 . This is a "BCBS-MCMINNVILLE" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 227289 , issued by the state of ( OR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 844477013 . This is a "BCBS-GRANTS PASS" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".
  • Identifier: 858463003 . This is a "BCBS-MEDFORD" identifier , issued by the state of ( OR ) . This identifiers is of the category "OTHER".




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