1962752535 NPI number — ROBERT W FARRELL MD PA

Table of content: (NPI 1962752535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962752535 NPI number — ROBERT W FARRELL MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ROBERT W FARRELL MD 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:
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:
1962752535
Entity Type Code:
Organization
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. SUITE 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
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. SUITE 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
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:
09/11/2012

Additional Information

Authorized Official

Authorized Official Last Name:
FARRELL
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
W
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
281-316-0331

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , 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: 20014 . This is a "HERITAGE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TXB165523 . This is a "HMO BLUE" 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: 926228 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: P00049BP8 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: S01503 . This is a "BLUE LINK" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: TXB165523 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 011427316 . This is a "TRICARE" 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".




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