1679851034 NPI number — PATIENT FOCUS MEDICAL PRACTICE, PA

Table of content: (NPI 1679851034)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679851034 NPI number — PATIENT FOCUS MEDICAL PRACTICE, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PATIENT FOCUS MEDICAL PRACTICE, 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:
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:
1679851034
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1700 COIT RD
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75075-6185
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-612-4007
Provider Business Mailing Address Fax Number:
972-612-3188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1700 COIT RD
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75075-6185
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-612-4007
Provider Business Practice Location Address Fax Number:
972-612-3188
Provider Enumeration Date:
08/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
PHILIPS
Authorized Official First Name:
SUNILA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
914-473-2481

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  N9113 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 02618422 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".
  • Identifier: L010180905 . This is a "DPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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