1962901538 NPI number — ID DOCS OF DALLAS PA

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962901538 NPI number — ID DOCS OF DALLAS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ID DOCS OF DALLAS 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:
1962901538
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/17/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
611 OAK GROVE LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COPPELL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75019-2407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-216-6273
Provider Business Mailing Address Fax Number:
469-969-0048

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4401 WEST SPRING CREEK PKWY
Provider Second Line Business Practice Location Address:
SUITE 400
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75021-5331
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-737-8299
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/08/2018

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LAXMI
Authorized Official First Name:
SHEETHAL
Authorized Official Middle Name:
M
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
732-216-6273

Provider Taxonomy Codes

  • Taxonomy code: 207RI0200X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)