1639164718 NPI number — YOUR HEALTHCARE SERVICES, LLC.

Table of content: (NPI 1639164718)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639164718 NPI number — YOUR HEALTHCARE SERVICES, LLC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
YOUR HEALTHCARE SERVICES, 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:
1639164718
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4801 S BUCKNER BLVD
Provider Second Line Business Mailing Address:
SUITE 1300
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75227-2373
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-682-5999
Provider Business Mailing Address Fax Number:
972-682-5699

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4801 S BUCKNER BLVD
Provider Second Line Business Practice Location Address:
SUITE 1300
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75227-2373
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-682-5999
Provider Business Practice Location Address Fax Number:
972-682-5699
Provider Enumeration Date:
09/15/2005

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
MACKEY
Authorized Official First Name:
MILTON
Authorized Official Middle Name:
ADAMS
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
972-682-5999

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)

  • Identifier: 10006497 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10968 . This is a "PARKLAND" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 531315 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".