1972115657 NPI number — FACES OF ANGELS DIAGNOSTICS LLC

Table of content: MEGAN MCMILLIN KINDRED APRN, IBCLC (NPI 1497219117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972115657 NPI number — FACES OF ANGELS DIAGNOSTICS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FACES OF ANGELS DIAGNOSTICS LLC
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:
1972115657
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/11/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1924 ENCINO DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANCASTER
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75146-7214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-514-1836
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 E BELT LINE RD STE 412
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DESOTO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75115-5706
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-514-1836
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/23/2020

Additional Information

Authorized Official

Authorized Official Last Name:
CRENSHAW
Authorized Official First Name:
JANAE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
214-514-1836

Provider Taxonomy Codes

  • Taxonomy code: 291U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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