NPIMap

Organization Active NPI

DO Not Use

  • Clinic/Center
  • Dallas, TX
National Provider Identifier
1689867368
Registry record updated Jan 31, 2008
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinic/CenterTaxonomy code 261Q00000X
Legal business name
DO NOT USE
Practice address
912 W 12TH St
Dallas, TX 75208-6005
Phone
(214) 946-6400
Fax
(214) 946-6402
NPI assigned
Aug 24, 2007
Last updated
Jan 31, 2008By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 31, 2008

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Jodi Krusely
Title
Account Manager
Phone
(847) 838-3832

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinic/Center 261Q00000X NU Primary

Addresses

Primary practice location

912 W 12TH St
Dallas, TX 75208-6005

Mailing address

1231 Greenway Dr
Suite 120
Irving, TX 75038-2533
Phone (972) 580-7700

National Provider Directory

National Provider Directory
Tax ID family
NFSG Veterans Health System107 organizations share this tax ID, including this one

Organizations with this tax ID in the same state 5

This tax ID family is large, so up to 24 of its organizations in the same state are linked here.

Locations

1231 Greenway Dr
Ste 120
Irving, TX 75038

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1187913600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1201737600000",
    "number": "1689867368",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1231 GREENWAY DR",
            "address_2": "SUITE 120",
            "city": "IRVING",
            "state": "TX",
            "postal_code": "750382533",
            "telephone_number": "972-580-7700",
            "fax_number": "972-580-7715"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "912 W 12TH ST",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752086005",
            "telephone_number": "214-946-6400",
            "fax_number": "214-946-6402"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DO NOT USE",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-08-24",
        "last_updated": "2008-01-31",
        "status": "A",
        "authorized_official_last_name": "KRUSELY",
        "authorized_official_first_name": "JODI",
        "authorized_official_title_or_position": "ACCOUNT MANAGER",
        "authorized_official_telephone_number": "847-838-3832"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dallas, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 31, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.