1649789819 NPI number — TEXOMA ER LLC

Table of content: (NPI 1649789819)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649789819 NPI number — TEXOMA ER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXOMA ER 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:
6
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:
1649789819
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/18/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2022 N US HIGHWAY 75
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:
75090-2802
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-357-5003
Provider Business Mailing Address Fax Number:
903-357-5077

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2022 N HWY 75
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHERMAN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75090
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-357-5003
Provider Business Practice Location Address Fax Number:
903-357-5077
Provider Enumeration Date:
09/20/2017

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
SHELBURNE
Authorized Official First Name:
JANCIE
Authorized Official Middle Name:
KRISTEN
Authorized Official Title or Position:
DON
Authorized Official Telephone Number:
903-357-5003

Provider Taxonomy Codes

  • Taxonomy code: 261QE0002X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 282N00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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