1962426882 NPI number — GREGG H LUCKSINGER M.D.

Table of content: GREGG H LUCKSINGER M.D. (NPI 1962426882)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962426882 NPI number — GREGG H LUCKSINGER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LUCKSINGER
Provider First Name:
GREGG
Provider Middle Name:
H
Provider Name Prefix Text:
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:
1962426882
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4534 W GATE BLVD STE 113
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78745-1470
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-388-5717
Provider Business Mailing Address Fax Number:
512-366-9575

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4534 W GATE BLVD STE 113
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
AUSTIN
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78745-1470
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-388-5717
Provider Business Practice Location Address Fax Number:
512-366-9575
Provider Enumeration Date:
07/26/2006

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: 207Q00000X , with the licence number:  H8222 , 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: 128222006 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 128222007 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 128222004 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: H8222 . This is a "TEXAS ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 85T411 . This is a "BLUE CROSS/BLUE SHIELD TX" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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