1619256591 NPI number — MEDICAL CLINIC OF NORTH TEXAS PLLC

Table of content: (NPI 1619256591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619256591 NPI number — MEDICAL CLINIC OF NORTH TEXAS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MEDICAL CLINIC OF NORTH TEXAS 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:
1619256591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/05/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9003 AIRPORT FWY
Provider Second Line Business Mailing Address:
STE 300
Provider Business Mailing Address City Name:
NORTH RICHLAND HILLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76180-7770
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-514-5200
Provider Business Mailing Address Fax Number:
817-514-5210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
800 5TH AVE
Provider Second Line Business Practice Location Address:
SUITE 300
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-7300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-334-1400
Provider Business Practice Location Address Fax Number:
817-334-1410
Provider Enumeration Date:
08/10/2011

Additional Information

Authorized Official

Authorized Official Last Name:
KENNEDY
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
817-514-5200

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com