1962592113 NPI number — HEART OF TEXAS INTERNAL MEDICINE ASSOCIATES, PA

Table of content: (NPI 1962592113)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962592113 NPI number — HEART OF TEXAS INTERNAL MEDICINE ASSOCIATES, PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEART OF TEXAS INTERNAL MEDICINE ASSOCIATES, 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:
1962592113
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/04/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 520
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BROWNWOOD
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76804-0520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-643-3300
Provider Business Mailing Address Fax Number:
325-641-8714

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
109 NORTH 2ND STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROSS PLAINS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76443-2401
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-725-7106
Provider Business Practice Location Address Fax Number:
254-725-7327
Provider Enumeration Date:
10/16/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ANDERSON
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
A
Authorized Official Title or Position:
CFO
Authorized Official Telephone Number:
325-643-3300

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  D0174 , 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