1588081731 NPI number — CHILDS PATH

Table of content: (NPI 1588081731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588081731 NPI number — CHILDS PATH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHILDS PATH
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:
1588081731
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 864557
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75086-4557
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-681-0344
Provider Business Mailing Address Fax Number:
214-291-5692

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8720 W MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75033-3079
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-681-0344
Provider Business Practice Location Address Fax Number:
214-291-5692
Provider Enumeration Date:
03/26/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BOATMAN
Authorized Official First Name:
CATHERINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR
Authorized Official Telephone Number:
214-681-0344

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  1-12-12040 , 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: 0002BF . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 12347082668 . This is a "TRICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1316338544 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1720332117 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1851718209 . This is a "NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 3639503 . This is a "UNITED HEALTH CARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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