1871623470 NPI number — CITY OF LEWISVILLE

Table of content: BRANDEN MICHAEL REID MD (NPI 1033340807)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871623470 NPI number — CITY OF LEWISVILLE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CITY OF LEWISVILLE
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:
6
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:
1871623470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/01/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 299002
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LEWISVILLE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75029-9002
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-219-3580
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
500 W ROUND GROVE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LEWISVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75067-8309
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-219-3558
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SPINUZZI
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSISTANT CHIEF
Authorized Official Telephone Number:
972-219-3558

Provider Taxonomy Codes

  • Taxonomy code: 341600000X , with the licence number:  061005 , 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: 086452201 . This is a "COOKS CHILDREN HEALTH INS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 086452201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 503829 . This is a "HORIZON MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 503829 . This is a "BLUE CROSS TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 503829 . This is a "BLUE CROSS FEDERAL TEXAS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 086452201 . This is a "PARKLAND COMMUNITY HEALTH" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 086452201 . This is a "AMERICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 238341700 . This is a "TWCC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 503829 . This is a "HMO BLUE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 590039900 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 086452201 . This is a "HMO BLUE STAR MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 086452202 . This is a "CSHCN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 086452201 . This is a "TEXAS HEALTH NETWORK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 086452201 . This is a "MEDICAID AETNS STAR" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 503829 . This is a "STERLING OPTION I PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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