1568688737 NPI number — P J NAIRNE DPM PLLC

Table of content: (NPI 1568688737)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568688737 NPI number — P J NAIRNE DPM PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
P J NAIRNE DPM 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:
1568688737
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
407 N CEDAR RIDGE DR
Provider Second Line Business Mailing Address:
225
Provider Business Mailing Address City Name:
DUNCANVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75116-3169
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-816-6030
Provider Business Mailing Address Fax Number:
972-299-9998

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
407 N CEDAR RIDGE DR
Provider Second Line Business Practice Location Address:
225
Provider Business Practice Location Address City Name:
DUNCANVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75116-3169
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-816-6030
Provider Business Practice Location Address Fax Number:
972-299-9998
Provider Enumeration Date:
04/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NAIRNE
Authorized Official First Name:
PAULETTE
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
PRIMARY MEMBER
Authorized Official Telephone Number:
972-816-6030

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , with the licence number:  1468 , 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: 177282401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 196280501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 018595101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com