1104409358 NPI number — THOMAS J CARTWRIGHT MD PLLC

Table of content: (NPI 1104409358)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104409358 NPI number — THOMAS J CARTWRIGHT MD PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THOMAS J CARTWRIGHT MD 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:
1104409358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
330 RAYFORD RD STE 397
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SPRING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77386-1980
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
281-824-3624
Provider Business Mailing Address Fax Number:
281-419-6788

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9200 PINECROFT DR STE 280
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHENANDOAH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77380-3281
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
281-824-3624
Provider Business Practice Location Address Fax Number:
281-419-6788
Provider Enumeration Date:
05/04/2021

Additional Information

Authorized Official

Authorized Official Last Name:
CARTWRIGHT
Authorized Official First Name:
THOMAS
Authorized Official Middle Name:
JACKSON
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
281-824-3624

Provider Taxonomy Codes

  • Taxonomy code: 207XS0117X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 125728901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: R0097252 . This is a "DPS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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