1821275769 NPI number — SNAPPER HEALTHCARE CLINIC, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821275769 NPI number — SNAPPER HEALTHCARE CLINIC, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SNAPPER HEALTHCARE CLINIC, 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:
1821275769
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/23/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11520 N CENTRAL EXPY
Provider Second Line Business Mailing Address:
SUITE 134
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75243-6605
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-504-6282
Provider Business Mailing Address Fax Number:
214-988-9018

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11520 N CENTRAL EXPY
Provider Second Line Business Practice Location Address:
SUITE 134
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75243-6605
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-504-6282
Provider Business Practice Location Address Fax Number:
214-988-9018
Provider Enumeration Date:
01/23/2008

Additional Information

Authorized Official

Authorized Official Last Name:
HOWLAND
Authorized Official First Name:
DARREN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
972-504-6282

Provider Taxonomy Codes

  • Taxonomy code: 261Q00000X , with the licence number:  9672 , 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)





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