1568657567 NPI number — NORTH TEXAS GASTROENTEROLOGY CONSULTANTS PA

Table of content: (NPI 1568657567)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568657567 NPI number — NORTH TEXAS GASTROENTEROLOGY CONSULTANTS PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH TEXAS GASTROENTEROLOGY CONSULTANTS PA
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:
1568657567
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
106 N DENTON TAP RD # 210-352
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COPPELL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75019-2138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
940-898-7488
Provider Business Mailing Address Fax Number:
940-243-3554

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3304 COLORADO BLVD STE 205
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76210-6877
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
940-898-7488
Provider Business Practice Location Address Fax Number:
940-243-3554
Provider Enumeration Date:
09/12/2007

Additional Information

Authorized Official

Authorized Official Last Name:
AWAN
Authorized Official First Name:
AMJAD
Authorized Official Middle Name:
NAEEM
Authorized Official Title or Position:
DOCTOR
Authorized Official Telephone Number:
940-898-7488

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  K9017 , 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: 141655403 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 8G0100 . This is a "BC/BS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 219119901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 141655402 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 141655404 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 141655405 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1073578753 . This is a "PERSONAL NPI" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: DH1825 . This is a "RAIL ROAD MEDICARE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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