1700990173 NPI number — MIAP, PC

Table of content: (NPI 1700990173)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700990173 NPI number — MIAP, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIAP, 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:
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:
1700990173
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
116 HALL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SEAGOVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75159
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-287-7474
Provider Business Mailing Address Fax Number:
972-287-7464

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
116 HALL RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SEAGOVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75159-2916
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-287-7474
Provider Business Practice Location Address Fax Number:
972-287-7464
Provider Enumeration Date:
08/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GELBER
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
L
Authorized Official Title or Position:
PHYSICAL ASSISTANT
Authorized Official Telephone Number:
972-287-7474

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 45D1024097 . This is a "CLIA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 178739202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 178739201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: DE6386 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 0072NH . This is a "BLUECROSSBLUESHIELD GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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