1891741179 NPI number — ELIZABETH CHANDY D.O.

Table of content: ELIZABETH CHANDY D.O. (NPI 1891741179)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891741179 NPI number — ELIZABETH CHANDY D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHANDY
Provider First Name:
ELIZABETH
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
F

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:
1891741179
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1600 HOSPITAL PKWY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEDFORD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76022-6913
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-848-2708
Provider Business Mailing Address Fax Number:
817-848-4579

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1600 HOSPITAL PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEDFORD
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76022-6913
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-848-2708
Provider Business Practice Location Address Fax Number:
817-848-4579
Provider Enumeration Date:
05/26/2006

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: 208M00000X , with the licence number:  M1046 , 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: M1046 , 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: 176191803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8F3315 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 1761918-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00315340 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 176191802 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8M7954 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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