1720609811 NPI number — INTEGRATED NEUROLOGY AND NEUROPHYSIOLOGY OF NORTH TEXAS

Table of content: (NPI 1720609811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720609811 NPI number — INTEGRATED NEUROLOGY AND NEUROPHYSIOLOGY OF NORTH TEXAS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTEGRATED NEUROLOGY AND NEUROPHYSIOLOGY OF NORTH TEXAS
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:
1720609811
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/30/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 E FM 544 STE 72
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURPHY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75094-4035
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-422-0140
Provider Business Mailing Address Fax Number:
972-422-0140

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
521 W SOUTHLAKE BLVD STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOUTHLAKE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76092-6173
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-328-3000
Provider Business Practice Location Address Fax Number:
827-328-3333
Provider Enumeration Date:
04/30/2020

Additional Information

Authorized Official

Authorized Official Last Name:
VAUGHAN
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
K
Authorized Official Title or Position:
NEUROLOGIST
Authorized Official Telephone Number:
972-520-6535

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1700873627 . This is a "MR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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