1851497952 NPI number — LINDA WROTEN P.C.

Table of content: (NPI 1851497952)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851497952 NPI number — LINDA WROTEN P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LINDA WROTEN P.C.
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:
SW GERIATRICS
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:
1851497952
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/31/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12650 N BEACH ST STE 114-25
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT WORTH
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76244-4256
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
520-314-3412
Provider Business Mailing Address Fax Number:
520-314-3413

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6890 E SUNRISE DR STE 120-176
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TUCSON
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85750-0738
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
520-314-3412
Provider Business Practice Location Address Fax Number:
520-314-3413
Provider Enumeration Date:
09/15/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WROTEN
Authorized Official First Name:
LINDA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
520-314-3412

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: NP0046 . This is a "BCBS" identifier . This identifiers is of the category "OTHER".




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