1861659880 NPI number — BROWN MEDICAL GROUP, P.A.

Table of content: (NPI 1861659880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861659880 NPI number — BROWN MEDICAL GROUP, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BROWN MEDICAL GROUP, P.A.
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:
1861659880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/25/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1592
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNT PLEASANT
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75456-1592
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-577-7100
Provider Business Mailing Address Fax Number:
903-577-7102

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2001 N JEFFERSON AVE
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
MOUNT PLEASANT
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75455-2338
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-577-7100
Provider Business Practice Location Address Fax Number:
903-577-7102
Provider Enumeration Date:
05/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BROWN
Authorized Official First Name:
CYNTHIA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
903-577-7100

Provider Taxonomy Codes

  • Taxonomy code: 207RC0200X , with the licence number:  M7876 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: M7876 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X , with the licence number: M7876 , 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: 0071RE . This is a "BCBS INDIVIDUAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1932106150 . This is a "INDIVIDUAL NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1903122 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0098RL . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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