1942376611 NPI number — TEXARKANA GALLERIA OAKS DIAGNOSTIC CENTER LLC

Table of content: (NPI 1942376611)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1942376611 NPI number — TEXARKANA GALLERIA OAKS DIAGNOSTIC CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TEXARKANA GALLERIA OAKS DIAGNOSTIC CENTER LLC
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:
1942376611
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2014 GALLERIA OAKS DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TEXARKANA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75503-4620
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
903-792-2990
Provider Business Mailing Address Fax Number:
903-792-2995

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
208 N 26TH ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
ARKADELPHIA
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
71923-4337
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-246-8022
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
11/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
VUORENNE
Authorized Official First Name:
NATALIE
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OFFICE MANAGER
Authorized Official Telephone Number:
903-792-2990

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com