1992110886 NPI number — PREMIER PSYCHIATRIC & SLEEP MEDICINE ASSOCIATES, PLLC

Table of content: (NPI 1992110886)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992110886 NPI number — PREMIER PSYCHIATRIC & SLEEP MEDICINE ASSOCIATES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREMIER PSYCHIATRIC & SLEEP MEDICINE ASSOCIATES, PLLC
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:
1992110886
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/25/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2705 GOLDEN MEADOW CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MCKINNEY
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75069-7440
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-600-3635
Provider Business Mailing Address Fax Number:
469-600-8101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3608 PRESTON ROAD
Provider Second Line Business Practice Location Address:
SUTIE 146
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75093
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-600-3635
Provider Business Practice Location Address Fax Number:
469-600-8101
Provider Enumeration Date:
06/30/2014

Additional Information

Authorized Official

Authorized Official Last Name:
RIAZ
Authorized Official First Name:
JAWAD
Authorized Official Middle Name:
Authorized Official Title or Position:
MD
Authorized Official Telephone Number:
972-985-7499

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  PL6710 , 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: 314479YSYF , issued by the state of ( TX ) . This identifiers is of the category "MEDICARE PIN".
  • Identifier: 326610801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: OTHOOO , issued by the state of ( TX ) . This identifiers is of the category "MEDICARE UPIN".




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