1952432965 NPI number — CHARLES W. PROCHERA, MD FCCP PA

Table of content: (NPI 1952432965)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952432965 NPI number — CHARLES W. PROCHERA, MD FCCP PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CHARLES W. PROCHERA, MD FCCP PA
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:
1952432965
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/08/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
816 KELLER PARKWAY
Provider Second Line Business Mailing Address:
STE 102
Provider Business Mailing Address City Name:
KELLER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76248-2479
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-337-0036
Provider Business Mailing Address Fax Number:
817-337-0053

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
816 KELLER PKWY
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
KELLER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76248-2479
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-337-0036
Provider Business Practice Location Address Fax Number:
817-337-0053
Provider Enumeration Date:
03/08/2007

Additional Information

Authorized Official

Authorized Official Last Name:
PROCHERA
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
817-337-0036

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  F5706 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RP1001X , with the licence number: F5706 , 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)





Copyright © 2007-2025 www.npivalidator.com