1427451905 NPI number — MS. TRACIE MCLAIN THORNTON PA-C

Table of content: MS. TRACIE MCLAIN THORNTON PA-C (NPI 1427451905)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427451905 NPI number — MS. TRACIE MCLAIN THORNTON PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THORNTON
Provider First Name:
TRACIE
Provider Middle Name:
MCLAIN
Provider Name Prefix Text:
MS.
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:
1427451905
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1 SUGAR CREEK CENTER BLVD STE 618
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SUGAR LAND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77478-3540
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-655-4141
Provider Business Mailing Address Fax Number:
713-457-5188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 SUGAR CREEK CENTER BLVD STE 618
Provider Second Line Business Practice Location Address:
UNIVERSAL SURGICAL ASSISTANTS
Provider Business Practice Location Address City Name:
SUGAR LAND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77478-3540
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-655-4141
Provider Business Practice Location Address Fax Number:
713-457-5188
Provider Enumeration Date:
09/29/2014

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: 363AS0400X , with the licence number:  PA09498 , 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: 436657YV3C . This is a "MEDICARE P-TAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8LH981 . This is a "BCBS - BLUE STAR SURGICAL ASSISTANTS LLC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 436657ZP6S . This is a "MEDICARE P-TAN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8354NR . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8HM768 . This is a "BCBS - UNIVERSAL SURGICAL PARTNERS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: PA09498 . This is a "TEXAS MEDICAL BOARD" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8353NR . This is a "BCBS - UNIVERSAL SURGICAL ASSISTANTS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 8235NV . This is a "BCBS - XCITE SURGICAL" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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