1831458132 NPI number — CENTENNIAL PRIMARY CARE PLLC

Table of content: (NPI 1831458132)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831458132 NPI number — CENTENNIAL PRIMARY CARE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTENNIAL PRIMARY CARE 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:
1831458132
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5520 INDEPENDENCE PKWY
Provider Second Line Business Mailing Address:
SUITE 201
Provider Business Mailing Address City Name:
FRISCO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75035-4606
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-383-0001
Provider Business Mailing Address Fax Number:
214-383-0068

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5520 INDEPENDENCE PKWY
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
FRISCO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75035-4606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-383-0001
Provider Business Practice Location Address Fax Number:
214-383-0068
Provider Enumeration Date:
05/08/2012

Additional Information

Authorized Official

Authorized Official Last Name:
AHMED
Authorized Official First Name:
NUZHAT
Authorized Official Middle Name:
F
Authorized Official Title or Position:
MANAGING DIRECTOR
Authorized Official Telephone Number:
512-656-1050

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X , with the licence number:  K3664 , 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)





Copyright © 2007-2025 www.npivalidator.com