1649483900 NPI number — NEUROLOGIC & SPINE INSTITUTE OF N.TX., PA

Table of content: (NPI 1649483900)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649483900 NPI number — NEUROLOGIC & SPINE INSTITUTE OF N.TX., PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NEUROLOGIC & SPINE INSTITUTE OF N.TX., PA
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:
1649483900
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:
PO BOX 2432
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHERMAN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75091-2432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-893-5177
Provider Business Mailing Address Fax Number:
903-813-0210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
300 N HIGHLAND AVE
Provider Second Line Business Practice Location Address:
SUITE 315
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75092-7388
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-893-5177
Provider Business Practice Location Address Fax Number:
903-813-0210
Provider Enumeration Date:
05/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
PULLIAM
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
903-893-5177

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  7071 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207T00000X , with the licence number: H0737 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 207T00000X , with the licence number: H6527 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 2084N0400X , with the licence number: K4507 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 225100000X , with the licence number: 1152290 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .
  • Taxonomy code: 363LA2100X , with the licence number: 257405 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "X" .

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

  • Identifier: 1992747638 . This is a "NPI NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1689686461 . This is a "NPI NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1588625263 . This is a "NPI NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1922042951 . This is a "NPI NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1245276500 . This is a "NPI NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1710923388 . This is a "NPI NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".