1871874628 NPI number — CHRISTIAN NEUROLOGY ASSOCIATES OF DALLAS PA

Table of content: (NPI 1871874628)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871874628 NPI number — CHRISTIAN NEUROLOGY ASSOCIATES OF DALLAS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHRISTIAN NEUROLOGY ASSOCIATES OF DALLAS PA
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:
1871874628
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/31/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 920407
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EL PASO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79902-0009
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-223-0062
Provider Business Mailing Address Fax Number:
214-515-9302

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1316 N YARBROUGH DR STE 1B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
EL PASO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79925-7814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-223-0062
Provider Business Practice Location Address Fax Number:
214-515-9302
Provider Enumeration Date:
09/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
COWENS
Authorized Official First Name:
KEVIN
Authorized Official Middle Name:
E
Authorized Official Title or Position:
OWNER - PROVIDER
Authorized Official Telephone Number:
469-223-0062

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , 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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