Basic Information
Provider Information | |||||||||
NPI: | 1144472598 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | PH DENTON PHYSICIANS INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 8440 WALNUT HILL LN | ||||||||
Address2: | SUITE 120 | ||||||||
City: | DALLAS | ||||||||
State: | TX | ||||||||
PostalCode: | 752313833 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2143455756 | ||||||||
FaxNumber: | 2143451452 | ||||||||
Practice Location | |||||||||
Address1: | 2501 SCRIPTURE ST | ||||||||
Address2: | SUITE 100 | ||||||||
City: | DENTON | ||||||||
State: | TX | ||||||||
PostalCode: | 762012313 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 9403233460 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/16/2008 | ||||||||
LastUpdateDate: | 07/02/2009 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MORTON | ||||||||
AuthorizedOfficialFirstName: | STAN | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
AuthorizedOfficialTelephone: | 9408987003 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X |   |   | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
ID Information
ID | Type | State | Issuer | Description | 6154210001 | 01 | TX | MEDICARE DME | OTHER |