1972538320 NPI number — MICHEL F LONGACRE DC

Table of content: MICHEL F LONGACRE DC (NPI 1972538320)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972538320 NPI number — MICHEL F LONGACRE DC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LONGACRE
Provider First Name:
MICHEL
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DC
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:
1972538320
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9229 LYNDON B JOHNSON FWY
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75243-3405
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-739-3097
Provider Business Mailing Address Fax Number:
972-739-2673

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 CROSS TIMBERS RD
Provider Second Line Business Practice Location Address:
STE 2070
Provider Business Practice Location Address City Name:
FLOWER MOUND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75028-1371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-549-1810
Provider Business Practice Location Address Fax Number:
469-549-1820
Provider Enumeration Date:
07/12/2006

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: 111N00000X , with the licence number:  8967 , 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: 166344501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 166344502 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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