1134520182 NPI number — 1 CP PLACE PLLC

Table of content: (NPI 1134520182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134520182 NPI number — 1 CP PLACE PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
1 CP PLACE 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:
1134520182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 251665
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLANO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75025-1515
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
469-331-0030
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7709 SAN JACINTO PL
Provider Second Line Business Practice Location Address:
SUITE 203
Provider Business Practice Location Address City Name:
PLANO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75024-3215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
469-331-0030
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/09/2014

Additional Information

Authorized Official

Authorized Official Last Name:
BRUNSTROM-HERNANDEZ
Authorized Official First Name:
JANICE
Authorized Official Middle Name:
ELAINE
Authorized Official Title or Position:
MANAGING MEMBER/ DIRECTOR
Authorized Official Telephone Number:
314-223-3306

Provider Taxonomy Codes

  • Taxonomy code: 2084N0402X , with the licence number:  M5074 , 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: 339119501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com