1720531296 NPI number — PODIATRIC MEDICAL PARTNERS OF TEXAS, PA

Table of content: (NPI 1720531296)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720531296 NPI number — PODIATRIC MEDICAL PARTNERS OF TEXAS, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PODIATRIC MEDICAL PARTNERS OF TEXAS, PA
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:
1720531296
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/16/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 N ZANG BLVD STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75208-4858
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-330-9299
Provider Business Mailing Address Fax Number:
866-846-5648

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2204 ITHACA AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
LUBBOCK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79410-1300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-793-6811
Provider Business Practice Location Address Fax Number:
806-793-9278
Provider Enumeration Date:
08/01/2016

Additional Information

Authorized Official

Authorized Official Last Name:
GALPERIN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, PRESIDENT
Authorized Official Telephone Number:
214-330-9299

Provider Taxonomy Codes

  • Taxonomy code: 213E00000X , 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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