1407893316 NPI number — PREFERRED HOSPITAL LEASING INC

Table of content: (NPI 1407893316)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407893316 NPI number — PREFERRED HOSPITAL LEASING INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PREFERRED HOSPITAL LEASING INC
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:
COLLINGSWORTH FAMILY MEDICINE
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:
1407893316
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1011 15TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WELLINGTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79095-3704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-447-5311
Provider Business Mailing Address Fax Number:
806-447-3090

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1011 15TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WELLINGTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79095-3704
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
806-447-5311
Provider Business Practice Location Address Fax Number:
806-447-3090
Provider Enumeration Date:
05/31/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FREEMAN
Authorized Official First Name:
DONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
VICE PRESIDENT
Authorized Official Telephone Number:
405-878-0202

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QR1300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363A00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 126840106 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 179285501 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 126840108 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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