1710958384 NPI number — DR. NANCY BEAMAN BANKS M.D.

Table of content: DR. NANCY BEAMAN BANKS M.D. (NPI 1710958384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1710958384 NPI number — DR. NANCY BEAMAN BANKS M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BANKS
Provider First Name:
NANCY
Provider Middle Name:
BEAMAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BEAMAN
Provider Other First Name:
NANCY
Provider Other Middle Name:
ALICE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1710958384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3445 EXECUTIVE CENTER DR
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78731-1678
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-579-4000
Provider Business Mailing Address Fax Number:
512-439-2814

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3445 EXECUTIVE CENTER DR
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78731-1678
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-579-4000
Provider Business Practice Location Address Fax Number:
512-439-2814
Provider Enumeration Date:
01/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207ZP0102X , with the licence number:  01057706A , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207ZP0102X , with the licence number: P2587 , 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: 344710401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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