1588091664 NPI number — PATRICK PEARSON ATP

Table of content: PATRICK PEARSON ATP (NPI 1588091664)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588091664 NPI number — PATRICK PEARSON ATP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PEARSON
Provider First Name:
PATRICK
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ATP
Provider Gender Code:
M

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:
1588091664
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/03/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9245 N MERIDIAN ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46260-1836
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-333-6033
Provider Business Mailing Address Fax Number:
317-333-6034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 W BEN WHITE BLVD
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78704-7035
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-420-4084
Provider Business Practice Location Address Fax Number:
877-884-5668
Provider Enumeration Date:
10/03/2013

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 332BC3200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: ATP 42658 . This is a "RESNA" identifier . This identifiers is of the category "OTHER".




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