1861491920 NPI number — DR. TODD ALAN PARRISH MD

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 1861491920 NPI number — DR. TODD ALAN PARRISH MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
PARRISH
Provider First Name:
TODD
Provider Middle Name:
ALAN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1861491920
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
612 N HIGH ST
Provider Second Line Business Mailing Address:
SUITE A
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75652-5914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-657-1441
Provider Business Mailing Address Fax Number:
903-655-1442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
203 NACOGDOCHES ST
Provider Second Line Business Practice Location Address:
SUITE 150
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75766-2462
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-586-6289
Provider Business Practice Location Address Fax Number:
903-589-0748
Provider Enumeration Date:
07/20/2005

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: 207X00000X , with the licence number:  J7829 , 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)

  • Identifier: 0857690-01 . This is a "MCD GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: CC8386 . This is a "RR MCR GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1040350 . This is a "BLUE LINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 166974901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00199785 . This is a "RR MCR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 00U762 . This is a "MCR GROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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