1932244217 NPI number — JOHN R. EVERETT

Table of content: (NPI 1932244217)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932244217 NPI number — JOHN R. EVERETT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHN R. EVERETT
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:
1932244217
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/12/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1121 DALLAS DR
Provider Second Line Business Mailing Address:
SUITE 6
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76205-5100
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1121 DALLAS DR
Provider Second Line Business Practice Location Address:
SUITE 6
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76205-5100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-387-2195
Provider Business Practice Location Address Fax Number:
940-565-5973
Provider Enumeration Date:
02/21/2007

Additional Information

Authorized Official

Authorized Official Last Name:
WALLACE
Authorized Official First Name:
MARGIT
Authorized Official Middle Name:
E
Authorized Official Title or Position:
SECRETARY
Authorized Official Telephone Number:
940-387-2195

Provider Taxonomy Codes

  • Taxonomy code: 332S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 146287101 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6274096 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 516541 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 2931013 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com