1124236856 NPI number — COURTNEY BUZBEE PA-C

Table of content: COURTNEY BUZBEE PA-C (NPI 1124236856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124236856 NPI number — COURTNEY BUZBEE PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BUZBEE
Provider First Name:
COURTNEY
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

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:
1124236856
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/02/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2021 N MACARTHUR BLVD
Provider Second Line Business Mailing Address:
STE 150
Provider Business Mailing Address City Name:
IRVING
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75061-2219
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
972-253-2560
Provider Business Mailing Address Fax Number:
972-253-4218

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
701 TUSCAN DR
Provider Second Line Business Practice Location Address:
STE 205
Provider Business Practice Location Address City Name:
IRVING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75039-4133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-253-2505
Provider Business Practice Location Address Fax Number:
972-253-2506
Provider Enumeration Date:
05/18/2007

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: 363A00000X , with the licence number:  PA02889 , 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: 3150211 01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: PA02889 . This is a "STATE LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com