1598126880 NPI number — VERITAS NP GROUP,LLC

Table of content: (NPI 1598126880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598126880 NPI number — VERITAS NP GROUP,LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
VERITAS NP GROUP,LLC
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:
1598126880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11625 CUSTER ROAD
Provider Second Line Business Mailing Address:
SUITE 110, #315
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75035-8784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-366-5533
Provider Business Mailing Address Fax Number:
888-859-0497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 CENTERVILLE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75228-2634
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-366-5533
Provider Business Practice Location Address Fax Number:
888-859-0497
Provider Enumeration Date:
03/14/2016

Additional Information

Authorized Official

Authorized Official Last Name:
BOLANOS
Authorized Official First Name:
SHEILA ROLANDA
Authorized Official Middle Name:
GAMBOA
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
972-366-5533

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  AP121789 , 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: 3618860 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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