1801279575 NPI number — MS. RACHEL FRITSCHE GORDON PA-C

Table of content: MS. RACHEL FRITSCHE GORDON PA-C (NPI 1801279575)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801279575 NPI number — MS. RACHEL FRITSCHE GORDON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GORDON
Provider First Name:
RACHEL
Provider Middle Name:
FRITSCHE
Provider Name Prefix Text:
MS.
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:
FRITSCHE
Provider Other First Name:
RACHEL
Provider Other Middle Name:
LAUREN
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:
1801279575
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/14/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4300 DUNLAVY ST
Provider Second Line Business Mailing Address:
APT #4137
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77006-5401
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-791-1414
Provider Business Mailing Address Fax Number:
713-794-8875

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
NORTHWEST HEALTH URGENT CARE-SILOAM SPRINGS
Provider Second Line Business Practice Location Address:
3721 US-412
Provider Business Practice Location Address City Name:
SILOAM SPRINGS
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72761
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
479-215-3080
Provider Business Practice Location Address Fax Number:
713-794-8875
Provider Enumeration Date:
06/30/2015

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: 363AM0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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