1679855852 NPI number — J.MICHAEL HATCHETT, DDS, PC MARK ALLAN THOMPSON, DDS, PC

Table of content: (NPI 1679855852)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1679855852 NPI number — J.MICHAEL HATCHETT, DDS, PC MARK ALLAN THOMPSON, DDS, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
J.MICHAEL HATCHETT, DDS, PC MARK ALLAN THOMPSON, DDS, PC
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:
1679855852
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/14/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
408 WYNN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75766-4976
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-586-6829
Provider Business Mailing Address Fax Number:
903-589-6801

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
408 WYNN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75766-4976
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-586-6829
Provider Business Practice Location Address Fax Number:
903-589-6801
Provider Enumeration Date:
09/14/2011

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
MARK
Authorized Official Middle Name:
ALLAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
903-586-6829

Provider Taxonomy Codes

  • Taxonomy code: 122300000X , with the licence number:  12913 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 122300000X , with the licence number: 12843 , 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: 1457458960 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 008650601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 008274501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1881776912 . This is a "INDIVIDUAL NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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