1942296330 NPI number — JOHN M HOUSE MD

Table of content: JOHN M HOUSE MD (NPI 1942296330)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942296330 NPI number — JOHN M HOUSE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HOUSE
Provider First Name:
JOHN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

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:
1942296330
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/02/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 W I-20
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76017-5851
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-784-8268
Provider Business Mailing Address Fax Number:
817-417-1150

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 W I-20
Provider Second Line Business Practice Location Address:
STE 1
Provider Business Practice Location Address City Name:
ARLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76017-5851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-784-8268
Provider Business Practice Location Address Fax Number:
817-417-1150
Provider Enumeration Date:
09/21/2005

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: 208800000X , with the licence number:  H3392 , 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: 133718009 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 133718004 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 133718007 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 133718010 . This is a "MEDICAID OTHER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 133718011 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 133718008 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com