1407973449 NPI number — JACK R. TOMLINSON

Table of content: (NPI 1407973449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407973449 NPI number — JACK R. TOMLINSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JACK R. TOMLINSON
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:
WICHITA FALLS NEUROPSYCHIATRIC CENTER
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:
1407973449
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/15/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2410 9TH ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA FALLS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76301-4033
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-723-0012
Provider Business Mailing Address Fax Number:
940-723-2058

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2410 9TH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WICHITA FALLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76301-4033
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-723-0012
Provider Business Practice Location Address Fax Number:
940-723-2058
Provider Enumeration Date:
03/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
YOUNG
Authorized Official First Name:
JUDY
Authorized Official Middle Name:
L
Authorized Official Title or Position:
OFFICE ADMINISTRATOR
Authorized Official Telephone Number:
940-723-0012

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  898 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 103TC0700X , with the licence number: 740 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2084P0800X , with the licence number: C6537 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 097024601 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: OA0231 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100151170A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".
  • Identifier: 033342901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8F9754 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8F9755 . This is a "MEDICARE ID-TYPE UNSPECIFIED" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 100841430A , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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