1760599377 NPI number — KATHERINE BORTHS PA-C

Table of content: KATHERINE BORTHS PA-C (NPI 1760599377)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760599377 NPI number — KATHERINE BORTHS PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BORTHS
Provider First Name:
KATHERINE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BECKMANN
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1760599377
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
17183 INTERSTATE 45 S STE 330
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SHENANDOAH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77385-3313
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-270-3655
Provider Business Mailing Address Fax Number:
936-270-3656

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
17183 INTERSTATE 45 S STE 330
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77385-3313
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-270-3655
Provider Business Practice Location Address Fax Number:
936-270-3656
Provider Enumeration Date:
08/23/2006

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: 363A00000X , with the licence number:  PA04358 , 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: 180726502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00391304 . This is a "RR MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8N8700 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8315NV . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 180726503 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 180726501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8FU755 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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