1578569893 NPI number — CONSULTANTS IN INFECTIOUS DISEASES

Table of content: (NPI 1578569893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578569893 NPI number — CONSULTANTS IN INFECTIOUS DISEASES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CONSULTANTS IN INFECTIOUS DISEASES
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:
1578569893
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/01/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 16327
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LUBBOCK
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79490-6327
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-795-8150
Provider Business Mailing Address Fax Number:
806-791-6688

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4404 C 19TH
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79407
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-795-8150
Provider Business Practice Location Address Fax Number:
806-791-6688
Provider Enumeration Date:
06/22/2005

Additional Information

Authorized Official

Authorized Official Last Name:
MARTINELLI
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
P
Authorized Official Title or Position:
MANAGING PARTNER
Authorized Official Telephone Number:
806-795-8150

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X , with the licence number:  J3849 , 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: 0541920001 . This is a "PALMETTO GBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 103131100 . This is a "FIRST CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 750678 . This is a "BCBS HOME INFUSION THERAP" identifier . This identifiers is of the category "OTHER".
  • Identifier: 082062301 . This is a "FIRST CARE STAR" identifier . This identifiers is of the category "OTHER".
  • Identifier: G9939 . This is a "NEW MEXICO MEDICAID" identifier . This identifiers is of the category "OTHER".
  • Identifier: 082062301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com