1952491052 NPI number — DR. ROBERT W FARRELL M.D.

Table of content: DR. ROBERT W FARRELL M.D. (NPI 1952491052)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952491052 NPI number — DR. ROBERT W FARRELL M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
FARRELL
Provider First Name:
ROBERT
Provider Middle Name:
W
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1952491052
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/10/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
450 BLOSSOM ST STE G
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WEBSTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77598-4200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-316-0331
Provider Business Mailing Address Fax Number:
281-316-0200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
450 BLOSSOM ST STE G
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEBSTER
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77598-4200
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-316-0331
Provider Business Practice Location Address Fax Number:
281-316-0200
Provider Enumeration Date:
10/13/2006

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: 207RI0011X , with the licence number:  G2697 , 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: 122242403 . This is a "MEDICAID TPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 20014 . This is a "HERITAGE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: S01503 . This is a "BLUE LINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TXB165524 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TXB165524 . This is a "HMO BLUE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 926228 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 10013103 . This is a "AMERIGROUP" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 122242403 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00049BP8 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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