1366838591 NPI number — EXPRESS CARE OF HOBBS

Table of content: (NPI 1366838591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1366838591 NPI number — EXPRESS CARE OF HOBBS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EXPRESS CARE OF HOBBS
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:
SEMINOLE EXPRESS CARE, LLC
Provider Other Organization Name Type Code:
3
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:
1366838591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/14/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3900 N LOVINGTON HWY
Provider Second Line Business Mailing Address:
SUITE 550
Provider Business Mailing Address City Name:
HOBBS
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88240-1160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
432-758-6015
Provider Business Mailing Address Fax Number:
432-758-6016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3900 N LOVINGTON HWY
Provider Second Line Business Practice Location Address:
SUITE 550
Provider Business Practice Location Address City Name:
HOBBS
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88240-1160
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
432-758-6015
Provider Business Practice Location Address Fax Number:
432-758-6016
Provider Enumeration Date:
04/14/2015

Additional Information

Authorized Official

Authorized Official Last Name:
BENSON
Authorized Official First Name:
ERICKA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
MEMBER-OWNER
Authorized Official Telephone Number:
432-758-6015

Provider Taxonomy Codes

  • Taxonomy code: 261QU0200X , with the licence number:  J6105 , 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)





Copyright © 2007-2024 www.npivalidator.com