1710436621 NPI number — TERRELL OBGYN CLINIC-HOLLIS PLLC

Table of content: (NPI 1710436621)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710436621 NPI number — TERRELL OBGYN CLINIC-HOLLIS PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TERRELL OBGYN CLINIC-HOLLIS 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:
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:
1710436621
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/02/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 JOE RAMSEY BLVD E
Provider Second Line Business Mailing Address:
STE E
Provider Business Mailing Address City Name:
GREENVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75401-7727
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-454-1722
Provider Business Mailing Address Fax Number:
903-454-1750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 TEJAS DR
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
TERRELL
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75160-6676
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-563-3334
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/03/2016

Additional Information

Authorized Official

Authorized Official Last Name:
PHIPPS
Authorized Official First Name:
KRISTI
Authorized Official Middle Name:
Authorized Official Title or Position:
EMPLOYEE
Authorized Official Telephone Number:
903-454-1722

Provider Taxonomy Codes

  • Taxonomy code: 207VX0000X , with the licence number:  N8191 , 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)





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