1801469218 NPI number — PRIME INFECTIOUS DISEASE GROUP PLLC

Table of content: (NPI 1801469218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801469218 NPI number — PRIME INFECTIOUS DISEASE GROUP PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRIME INFECTIOUS DISEASE GROUP 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:
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:
1801469218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 251104
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75025-1104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
WOUNDE CARE CENTER
Provider Second Line Business Practice Location Address:
7 MEDICAL PKWY
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75234-7829
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-453-8118
Provider Business Practice Location Address Fax Number:
972-888-7047
Provider Enumeration Date:
07/22/2021

Additional Information

Authorized Official

Authorized Official Last Name:
KACHHDIYA
Authorized Official First Name:
SURESH
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
469-453-8118

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com