1538439724 NPI number — LUNG DOCTORS FOR CHILDREN, PLLC

Table of content: (NPI 1538439724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538439724 NPI number — LUNG DOCTORS FOR CHILDREN, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LUNG DOCTORS FOR CHILDREN, 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:
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:
1538439724
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/09/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
751 W MAIN ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75067-3513
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
927-219-5864
Provider Business Mailing Address Fax Number:
972-219-5866

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
751 W MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
LEWISVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75067-3513
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
927-219-5864
Provider Business Practice Location Address Fax Number:
972-219-5866
Provider Enumeration Date:
01/05/2012

Additional Information

Authorized Official

Authorized Official Last Name:
REMBECKI
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
M
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
469-878-6185

Provider Taxonomy Codes

  • Taxonomy code: 2080P0214X , with the licence number:  J2461 , 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: 2934692002 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 015857-0082 . This is a "PACIFICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1151805-04 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2916754 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: A003 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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