1912648346 NPI number — ARVINA MEDICAL GROUP PC

Table of content: (NPI 1912648346)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912648346 NPI number — ARVINA MEDICAL GROUP PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ARVINA MEDICAL GROUP PC
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:
1912648346
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/07/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2410 LUNA RD STE 248
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARROLLTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75006-6578
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2068 WHEATON WAY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SANDY SPRINGS
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
30328-4954
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
972-318-9731
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/07/2022

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
THOMAS
Authorized Official First Name:
STAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
972-318-9731

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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