1700017837 NPI number — HAVANT, PLLC

Table of content: (NPI 1700017837)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700017837 NPI number — HAVANT, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HAVANT, PLLC
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:
1700017837
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 W 15TH ST
Provider Second Line Business Mailing Address:
SUITE 503
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75075-7751
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-596-5522
Provider Business Mailing Address Fax Number:
469-362-6545

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2821 E PRESIDENT GEORGE BUSH HWY
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
RICHARDSON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75082-4266
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-234-9100
Provider Business Practice Location Address Fax Number:
469-362-6545
Provider Enumeration Date:
08/06/2009

Additional Information

Authorized Official

Authorized Official Last Name:
MOFFETT
Authorized Official First Name:
MICHELLE
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
469-362-6543

Provider Taxonomy Codes

  • Taxonomy code: 207RC0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com