1679820674 NPI number — BETTYES HEALTHCARE NETWORK, INC.

Table of content: (NPI 1679820674)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679820674 NPI number — BETTYES HEALTHCARE NETWORK, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETTYES HEALTHCARE NETWORK, INC.
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:
1679820674
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 N EAST ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76011-7202
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-322-2162
Provider Business Mailing Address Fax Number:
817-200-6041

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 N EAST ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76011-7202
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-322-2162
Provider Business Practice Location Address Fax Number:
817-200-6041
Provider Enumeration Date:
08/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
REEVES
Authorized Official First Name:
TONYA
Authorized Official Middle Name:
LASHELLE
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
972-322-2162

Provider Taxonomy Codes

  • Taxonomy code: 251B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2025 www.npivalidator.com