1790292118 NPI number — PASR, PLLC

Table of content: (NPI 1790292118)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790292118 NPI number — PASR, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PASR, 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:
PEDIATRIC & ADOLESCENT SPECIALISTS OF ROCKWALL
Provider Other Organization Name Type Code:
3
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:
1790292118
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6435 S FM 549 STE 201
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HEATH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75032-6225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-771-3712
Provider Business Mailing Address Fax Number:
214-771-3796

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6435 S FM 549 STE 201
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HEATH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75032-6225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-771-3712
Provider Business Practice Location Address Fax Number:
214-771-3796
Provider Enumeration Date:
01/08/2018

Additional Information

Authorized Official

Authorized Official Last Name:
SONNEN
Authorized Official First Name:
GREGORY
Authorized Official Middle Name:
MATTHEW
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
214-771-3712

Provider Taxonomy Codes

  • Taxonomy code: 207QA0000X , with the licence number:  J3871 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: K5213 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 208000000X , with the licence number: L2797 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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