1992952246 NPI number — LAURIE MCKILLIP M.D., P.A.

Table of content: (NPI 1992952246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1992952246 NPI number — LAURIE MCKILLIP M.D., P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LAURIE MCKILLIP M.D., P.A.
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:
1992952246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/06/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1120 MEDICAL PLAZA DR
Provider Second Line Business Mailing Address:
SUITE 250
Provider Business Mailing Address City Name:
SHENANDOAH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77380-3242
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-296-8500
Provider Business Mailing Address Fax Number:
281-296-8594

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1120 MEDICAL PLAZA DR
Provider Second Line Business Practice Location Address:
SUITE 250
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380-3242
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-296-8500
Provider Business Practice Location Address Fax Number:
281-296-8594
Provider Enumeration Date:
08/19/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MCKILLIP
Authorized Official First Name:
LAURIE
Authorized Official Middle Name:
Authorized Official Title or Position:
PHYSICIAN/OWNER
Authorized Official Telephone Number:
281-296-8500

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  G9021 , 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: G9021 . This is a "TEXAS LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8A0972 . This is a "BLUE CROSS & BLUE SHEILD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 586248 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 03741 . This is a "CIGNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 976050 . This is a "AETNA" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: E79307 . This is a "UPIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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