1700812161 NPI number — SOUTHWEST PODIATRY, LLP

Table of content: (NPI 1700812161)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700812161 NPI number — SOUTHWEST PODIATRY, LLP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SOUTHWEST PODIATRY, LLP
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:
1700812161
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/12/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18208 PRESTON RD
Provider Second Line Business Mailing Address:
SUITE D-9 LB 112
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75252-6007
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-566-3808
Provider Business Mailing Address Fax Number:
972-566-4690

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18208 PRESTON RD
Provider Second Line Business Practice Location Address:
SUITE D-9 LB 112
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75252-6007
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-566-3808
Provider Business Practice Location Address Fax Number:
972-566-4690
Provider Enumeration Date:
06/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BLUM
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
MANAGING PARTNER, SOUTHWEST PODIATR
Authorized Official Telephone Number:
972-566-3808

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: CH3133 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0036DX . This is a "BCBS GROUP NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 080802401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com