1942298682 NPI number — PREFERRED QUALITY MEDICAL SERVICES

Table of content: (NPI 1942298682)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942298682 NPI number — PREFERRED QUALITY MEDICAL SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED QUALITY MEDICAL SERVICES
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:
1942298682
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/08/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
112 WESTMINISTER AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MURPHY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75094-4413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-384-1148
Provider Business Mailing Address Fax Number:
972-384-1149

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
405 MAYFIELD AVE
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
GARLAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75041-5420
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-205-1160
Provider Business Practice Location Address Fax Number:
972-278-5750
Provider Enumeration Date:
10/06/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DANIEL
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
A
Authorized Official Title or Position:
MANGER/OWNER
Authorized Official Telephone Number:
972-205-1160

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 156209201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 156209202 . This is a "MEDICAID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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