1558480459 NPI number — PLAINVIEW PRIMARY CARE, P.A.

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 1558480459 NPI number — PLAINVIEW PRIMARY CARE, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PLAINVIEW PRIMARY CARE, P.A.
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:
1558480459
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
401 S WESTRIDGE RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLAINVIEW
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79072-0764
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-296-7944
Provider Business Mailing Address Fax Number:
806-296-7944

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 DIMMITT RD
Provider Second Line Business Practice Location Address:
DIRECTOR OF EMERGENCY MEDICINE, #407
Provider Business Practice Location Address City Name:
PLAINVIEW
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79072-1833
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-296-7944
Provider Business Practice Location Address Fax Number:
806-296-7984
Provider Enumeration Date:
03/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
TURKOWSKI
Authorized Official First Name:
WALTER
Authorized Official Middle Name:
JOSEPH
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
806-296-7944

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  K0224 , 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)





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