1891744033 NPI number — INTERIM HEALTHCARE OF DALLAS LP

Table of content: (NPI 1891744033)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1891744033 NPI number — INTERIM HEALTHCARE OF DALLAS LP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERIM HEALTHCARE OF DALLAS LP
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:
1891744033
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12750 MERIT DR
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75251-1214
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
214-360-9090
Provider Business Mailing Address Fax Number:
214-987-4384

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12750 MERIT DR
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
DALLAS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75251-1214
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
214-360-9090
Provider Business Practice Location Address Fax Number:
214-987-4384
Provider Enumeration Date:
05/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
S
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
918-749-9933

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  7640 , 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: 1623449-01 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7640 . This is a "STATE LICENCE NUMBER" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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