1962426452 NPI number — THOMAS A CADENHEAD MD

Table of content: THOMAS A CADENHEAD MD (NPI 1962426452)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962426452 NPI number — THOMAS A CADENHEAD MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CADENHEAD
Provider First Name:
THOMAS
Provider Middle Name:
A
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:
1962426452
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/11/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
409 CENTRAL PARK DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ARLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76014-2069
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-261-9191
Provider Business Mailing Address Fax Number:
817-784-6880

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2210 SAN JACINTO BLVD STE 2
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76205-7531
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-898-8569
Provider Business Practice Location Address Fax Number:
940-898-7444
Provider Enumeration Date:
07/27/2006

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: 207Y00000X , with the licence number:  G8677 , 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: 115093003 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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